Objective : To assess surgical outcome after oesophagectomy, we reviewed operative
techniques and postoperative course of 90 patients who underwent oesophageal resection
for malignant disease from 1.1.1989 through 31.12.1995.
Material and Methods: There were 73 males and 17 females, mean age was 64.2 years
(range: 21-78 years). Indications for resection were oesophageal epidermoid carcinoma in
49 patients and oesophageal adenocarcinoma in forty-one. Preoperative treatment
consisted in chemotherapy in seven patients and in combined radiochemotherapy in
eighteen. There were fifty-six total thoracic oesophagectomies, with anastomosis in the
neck in 34 patients and at the thoracic inlet in twenty-two, and thirty-four distal
oesophageal resections. Digestive continuity was restored with the stomach in 62 patients,
a colonic graft in twenty-four, and a jejunal loop in four. A jejunostomy was performed in
48 patients.
Results : Hospital mortality was 10 per cent, and 30-day mortality was 7 per cent.
Comparing the periods until 1992 and since 1993, both hospital and 30-day mortalities
decreased respectively from 18.5 per cent to 3.8 per cent, and from 10.5 per cent to 3.8
per cent. Among the nine patients who died, five had a total oesophagectomy, and in all
but one a gastric transplant was used. Nonfatal postoperative complications occurred in 32
patients (nine in the colonic graft group and twenty-three in the gastric pull-up group), and
consisted in pulmonary insufficiency or infection in 26 patients, cerebrovascular accident in
one, renal insufficiency in two, recurrent nerve palsy in four, and anastomotic fistula in six.
We observed 18 pulmonary complications in the subgroup of patients who received
preoperative chemotherapy.
Conclusions :
1) with experience, major oesophageal resection can be performed with low mortality,
2) in our hands, the use of the colon as a substitute doesn’t increase the incidence of perioperative
complications, and
3) there is a significant increase in the incidence of pulmonary complications in the group
of patients who received preoperative chemotherapy.