Relationships between operative approaches and outcomes in esophageal cancer

Rodney Pommier, John Vetto, Brian L. Ferris, Thea J. Wilmarth

    Research output: Contribution to journalArticle

    50 Citations (Scopus)

    Abstract

    BACKGROUND: Controversy exists whether patients with esophageal carcinoma are best managed with Ivor-Lewis (IL) or transhiatal (TH) esophagectomy. The TH approach is presumed to be superior with respect to operative time, leak rates, morbidity/mortality, and length of stay (LOS), but may represent an inferior cancer operation compared with formal IL. Accordingly, we reviewed the results of our esophageal resections to compare these outcome parameters for each operative approach. METHODS: We performed a retrospective review of all esophagectomies performed at Oregon Health Sciences University and Portland Veterans Affairs Medical Center between 1987 and 1996. Survival was determined by the Kaplan-Meier method, and comparisons between the IL and TH groups were made with Student's t test, Fisher's exact test, and log-rank analysis. RESULTS: Seventy-eight patients were identified. Forty patients had IL and 38 had TH. Fifty-eight patients had adenocarcinoma, 19 had squamous cell, and 1 had an unknown histology. Mean operative time was 389 minutes for IL versus 275 minutes for TH (P = 0.0001). Leak rates were 7.5% for IL and 13% for TH (P = 0.21). There were no significant differences between IL and TH with respect to other types of complications, operative deaths, blood loss, need for transfusion, LOS, stricture rates, or need for dilatation. Overall mean survival was 12 months. Mean survival rates were 8 months for IL and 12 for TH (P = NS), and were also equivalent when compared by histology and stage for stage. CONCLUSIONS: We conclude that IL and TH are comparable operations with equivalent survival rates. The TH approach did not decrease the incidence of complications, transfusions, leaks, strictures, or subsequent dilatations. Although TH requires less operating room time, this does not translate into a decrease in LOS. Either approach appears to be acceptable depending on surgeons' preferences and appropriate patient selection.

    Original languageEnglish (US)
    Pages (from-to)422-425
    Number of pages4
    JournalAmerican Journal of Surgery
    Volume175
    Issue number5
    DOIs
    StatePublished - 1998

    Fingerprint

    Esophageal Neoplasms
    Length of Stay
    Esophagectomy
    Operative Time
    Dilatation
    Histology
    Pathologic Constriction
    Survival Rate
    Survival
    Veterans
    Operating Rooms
    Patient Selection
    Adenocarcinoma
    Epithelial Cells
    Students
    Morbidity
    Carcinoma
    Mortality
    Incidence
    Health

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Relationships between operative approaches and outcomes in esophageal cancer. / Pommier, Rodney; Vetto, John; Ferris, Brian L.; Wilmarth, Thea J.

    In: American Journal of Surgery, Vol. 175, No. 5, 1998, p. 422-425.

    Research output: Contribution to journalArticle

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    abstract = "BACKGROUND: Controversy exists whether patients with esophageal carcinoma are best managed with Ivor-Lewis (IL) or transhiatal (TH) esophagectomy. The TH approach is presumed to be superior with respect to operative time, leak rates, morbidity/mortality, and length of stay (LOS), but may represent an inferior cancer operation compared with formal IL. Accordingly, we reviewed the results of our esophageal resections to compare these outcome parameters for each operative approach. METHODS: We performed a retrospective review of all esophagectomies performed at Oregon Health Sciences University and Portland Veterans Affairs Medical Center between 1987 and 1996. Survival was determined by the Kaplan-Meier method, and comparisons between the IL and TH groups were made with Student's t test, Fisher's exact test, and log-rank analysis. RESULTS: Seventy-eight patients were identified. Forty patients had IL and 38 had TH. Fifty-eight patients had adenocarcinoma, 19 had squamous cell, and 1 had an unknown histology. Mean operative time was 389 minutes for IL versus 275 minutes for TH (P = 0.0001). Leak rates were 7.5{\%} for IL and 13{\%} for TH (P = 0.21). There were no significant differences between IL and TH with respect to other types of complications, operative deaths, blood loss, need for transfusion, LOS, stricture rates, or need for dilatation. Overall mean survival was 12 months. Mean survival rates were 8 months for IL and 12 for TH (P = NS), and were also equivalent when compared by histology and stage for stage. CONCLUSIONS: We conclude that IL and TH are comparable operations with equivalent survival rates. The TH approach did not decrease the incidence of complications, transfusions, leaks, strictures, or subsequent dilatations. Although TH requires less operating room time, this does not translate into a decrease in LOS. Either approach appears to be acceptable depending on surgeons' preferences and appropriate patient selection.",
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