• Title/Summary/Keyword: Esophagogastrectomy

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The surgical experiences of esophageal reconstruction with stomach at the middle and lower esophageal and cardia cancer (중,하부 식도및 분문에 발생한 식도 종양의 위장을 이용한 식도재건술의 외과적 치험)

  • 강경민;박재홍
    • Journal of Chest Surgery
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    • v.29 no.6
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    • pp.626-631
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    • 1996
  • The forty patients with carcirLoma of the esophagus or cardia seen at National Medical Center between November 1983 and April 1994 underwent surgical exploration. The esophagogastrectomy was carried out in 29 of 40 patients, one case through right thoracotomy, the others through left thoracotomy. Two patients underwent colon bypass surgeries due to upper esophageal cancer Transhiatal esop agectomy was performed In one case. Feeding gastrostomy or feeding jejunostomy were performed in 8 patients due to the advanced stage or malnutrition. In this report, we evaluated the long-term results in the 28 patients who underwent esophagogastrectomy for palliation through the left thoracotomy. There were 25 men(89%) and 3 women(11 %), and the mean age was 58.65$\pm$7.15 years(range, 46 to 73 years). The most frequent preoperative symptoms included dysphagia (22), weight loss (15), chest pain (6), vomiting (1), and hoarsness (1). Twenty-three patients had sqamous cell cancers of mid-and lower esophagus and five adenocarcionomas of cardia. One patient died in the hospital within 30 days of the op- eration for a hospital mortality rate of ).7%, Cause of death was sepsis due to anastomotic leakage. There were five additional complications in five patients; acute respiratory distress syndrome (1), post-op- erative bleeding (1), diaphragmatic hernia (1), acute renal failure (1) and late raft stenosis (1). The one year, 1틴o years, and three years acturial survival rate were 75.6$\pm$9.5%, 43.2$\pm$ 11.6%, 21.6: 10.5$\circledcirc$ re- spectively. The average survival was 21.8 months. The data from this study suggest that esophagogastrectomy through the left thoracotomy can achieve resonable long-term palliation for carci- noma of the esophagus. The operation can be performed with a low operative mortality and few serious postoperative complications.

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Reoperation after esophagomyotomy for achalasia of the esophagus: report of 3 cases (식도 Achalasia 에 대한 재수)

  • Yu, Hoe-Seong;Nam, Chung-Hui;Park, Guk-Yang
    • Journal of Chest Surgery
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    • v.17 no.4
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    • pp.792-795
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    • 1984
  • The modified Hellers myotomy for esophageal achalasia is known as the best procedure. A properly performed transthoracic esophagomyotomy is essential to prevent complications. But it has some problems such as persistent achalasia due to inadequate myotomy, recurrence due to the healing of myotomy and reflux esophagitis due to destruction of the lower esophageal sphincter. The methods of the reoperation after esophagomyotomy for achalasia of the esophagus consist of 1 ] for persistent achalasia due to inadequate myotomy, additional myotomy feasible. 2] for esophageal reflux, a long-limb jejunal gastric drainage after vagotomy and hemigastrectomy, jejunal after conservative resection for stricture. We experienced 3 cases of reoperation after esophagomyotomy for achalasia of the esophagus. The 1st and 3rd case belongs to 30 cases which were undertaken the primary operation at the National Medical Center from 1961 to 1984. The 2nd case was undertaken the primary operation at other hospital. The 1st and 3rd case were reoperated because of persistent achalasia due to inadequate myotomy and 2rid case was caused by stricture due to reflux esophagitis. The methods of the reoperation were additional myotomy in 1st case, esophagogastrectomy and lower thoracic esophagogastrostomy in 2nd case, and esophagogastrectomy and mid-thoracic esophagogastrostomy in 3rd case. All three cases were complicated with postoperative reflux esophagitis.

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Role of Crural Diaphragm after Esophagogastrectomy (식도-위 절제술 후 횡격막 crura의 역할)

  • 조성래;하현철;이봉근;조봉균
    • Journal of Chest Surgery
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    • v.34 no.10
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    • pp.763-768
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    • 2001
  • Background: The high pressure zone(HPZ) at the gastroesophageal junction is an important barrier for prevention of gastroesophageal reflux. Smooth muscle layers in the lower esophageal sphincter mainly contributes to HPZ at the throacoabdominal junction. The purpose of this study was to investigate the manometric characteristics of the thora-coabdominal junction in patients after surgical removal of the lower esophageal sphincter. Material and Method: Twenty two patients with prior esophagogastrectomy(10 Ivor-Lewis method and 12 left thoracotomy) and 30 normal adults(control group) were studied manometrically. Result: Esophageal manometry showed a HPZ and pressure inversion points distal to the anastomosis in 12 of 22 patients(2 of 10 patients with Ivor-Lewis method and 10 of 12 patients with left thoracotomy) and a HPZ in 30 of 30 normal adults. The location of HPZ front nostril was not significant different between the two groups(42.5$\pm$0.9cm in patients and 43.9$\pm$2.1cm in the control), while the length of HPZ was shorter in patients than in the control(2.13$\pm$0.6cm vs 2.83$\pm$0.59cm). By SPT and RPT, pressures of HPZ at rest were lower in patients(13.78$\pm$1.63mmHg, 28.58$\pm$6.06mmHg) than in control(20.3$\pm$4.95mmHg, 42.80$\pm$15.91mmHg). The HPZ relaxed partially in response to deglutition(84.4% in patient, 90.5% in control group) and contracted in response to increased intra- abdominal pressure induced by leg lifts(HPZ/ Intra-abdominal pressure= 1.81$\pm$0.23 in patient, 2.13$\pm$ 0.58 in control group).

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Postoperative complications and mortality in esophageal carcinoma (식도암의 외과적 치료후 합병증 및 사망률에 대한 고찰)

  • 유회성
    • Journal of Chest Surgery
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    • v.17 no.2
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    • pp.275-279
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    • 1984
  • Between June 1, 1971 and June 31, 1983, 90 patients of esophageal carcinoma were experienced at N.M.C. Surgery was applied to 63 patients [70%]; Exploratory operations, including feeding gastrostomy, feeding jejunostomy, & esophagecutenostomy with feeding gastrostomy, was done in 26 patients due to advanced stage or general condition. Esophagogastrectomy [or esophagectomy] with esophagogastrostomy was done in 25 patients, curative operation in 9 patients & palliative operation in 16 patients. Colon bypass in 12 patients, 7 cases with tumor resection & 5 cases without resection. Postoperative complications were anastomotic leakage [14.3%], respiratory complications [19.1%], & others. Anastomotic leakage & respiratory complications were major fatal complication in surgery of esophageal carcinoma. Postoperative mortality was mainly due to respiratory complications [14.3%] & anastomotic leakage [7.9%].

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Early Postoperative results of Esophageal Carcinoma using EEA Stapler (EEA Stapler 를 이용한 식도암 수술의 조기 성적)

  • 조성래
    • Journal of Chest Surgery
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    • v.23 no.2
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    • pp.309-315
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    • 1990
  • The introduction of end-to-end anastomosis stapler [EEA stapler] into esophageal surgery has reduced the mortality and morbidity associated with esophageal resection mainly owing to a reduction in the incidence of accidence of anastomotic leak. We now report the results of the 37 patients undergoing esophagectomy or esophagogastrectomy with EEA stapler in the department of cardiothoracic Surgery, Kosin Medical Center No leakage was demonstrated in the 37 esophagogastric anastomotic sites, but dehiscence of the TA stapled gastrotomy suture line occurred in two patient One patient was recovered with conservative treatment but the other patient was died due to hepatic metastasis of esophageal carcinoma during conservative treatment. And one severe esophagogastric anastomotic stricture was developed at the 30th postoperative day, but improved after dilatation with balloon dilatation catheter of Swiss Med. Tech. Company. The other complications were postoperative pneumonia[1 case], wound disruption and infection[3 cases], but all of 4 patients were recovered with conservative treatment. We experienced relative good postoperative results with use of EEA stapler in esophageal surgery. On the basis of our experience, we believe that the EEA stapler has definite place in esophageal surgery.

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A Case of Total Pharyngo-laryngo-esophagogastrectomy and Colon Transposition in a Patient with Esophageal Cancer following Partial Esophagectomy and Gastic Pull-up due to Esophageal Stricture (식도협착으로 식도부분절제술과 위간치술 후 발생한 식도암에서 시행한 전인두후두식도위적출술 및 대장치환술 치험 1예)

  • 왕수건;손봉형;이병주;이형렬
    • Korean Journal of Bronchoesophagology
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    • v.9 no.2
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    • pp.69-73
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    • 2003
  • Various flaps are using for reconstruction of esophageal defect. The choice of reconstruction is depended to the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor, then total esophagectomy and gastric pull-up or colon transposition is indicated. But for most hypopharyngeal tumors, laryngopharyngeal tumors, and cervical esophageal tumors, segmental resection of these area and replacement with a jejunal fee or forearm free flap has become the standard technique. The authors have experienced a case of total pharyngo-laryngo-esophago-gastrectomy and colon transposition in a patient of esophageal cancer following partial esophagectomy and gastic pull-up due to corrosive esophageal stricture. We report this case with brief review of the literatures.

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Experience with a Safe Anastomotic Method for Ivor Lewis Operation (Ivor Lewis 수술 후 발생되는 문합 부위 합병증을 예방하기 위한 술식 평가)

  • Kim, Jeong-Won;Lee, Yong-Jik;Chang, Yong-Jin;Park, Chang-Ryul;Jung, Jong-Pil
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.625-629
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    • 2008
  • Background: When it comes to esophageal cancer operations, the prevalence of anastomotic complications that adversely affect quality of life is related to the type of anastomotic procedure and the operative site. We studied outcomes related to a safe anastomotic method used in Ivor Lewis esophagogastrectomy for preventing anastomotic leakage and stricture formation. Material and Method: Between May 2003 and April 2007, 18 patients with esophageal cancer underwent this type of esophagogastrectomy. Four people were lost to follow-up. There were 17 men (94.4%) and 1 woman. The mean patient age was 61 years (range, $46{\sim}73$ years). Result: The mean follow-up period was 17.2 months (range, $1{\sim}45$ months). There was no anastomotic leakage. There was one benign anastomotic stricture (5.6%) requiring esophageal balloon dilatation, which was accomplished with a 25 mm circular stapler. Conclusion: We experienced relatively good postoperative results using a safe anastomotic method in the Ivor lewis operation for preventing anastomotic complications. These results suggest that this anastomotic method is effective in reducing the incidence of benign anastomotic complications.

An Exclusive Right Thoracic Approach for Cancer of The Middle Third of the Esophagus -A Case Report- (우측개흉(右側開胸)으로 수술치료(手術治療)한 식도중간부위(食道中間部位)의 악성종양(惡性腫揚) -일례(一例) 보고(報告)-)

  • Lee, Nam-Soo
    • Journal of Chest Surgery
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    • v.9 no.2
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    • pp.293-297
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    • 1976
  • One mid-esophageal carcinoma underwent esophagogastrectomy using an exclusive right thoracic approach entailing mobilization of the stomach through the esophageal hiatus. 62 year old male farmer was admitted with chief complaints of dysphagia and weight loss of 5 Kg. for 6 months, and regurgitation after soft meal for one week prior to this admission. Preoperative esophagogram revealed stricture with fungating mass at the level of the carina, which was diagnosed as squamous cell carcinoma at the time of esophagoscopic biopsy about 33 cm from incisor. Bronchoscopy revealed no invasive lesion or carinal fixation, and laboratory examinations were excellent for operative intervention. An exclusive right thoracic approach through right 5th rib bed was made for radical esophagectomy, mobilization of the stomach through the esophageal hiatus and primary esophagectomy. Postoperative recovery was uneventful except increased bronchial secretion due to senile emphysema, and follow up for 5 months after esophagectomy revealed good functioning esophagus with mild epigastric fullness after meal. Exclusive right thoracic approach for radical esophagectomy seems to be the procedure of choice in selected cases.

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Diffuse-Type Histology Is Prognostic for All Siewert Types of Gastroesophageal Adenocarcinoma

  • Kelly M Mahuron;Kevin M Sullivan;Matthew C Hernandez;Yi-Jen Chen;Joseph Chao;Laleh G Melstrom;I. Benjamin Paz;Jae Yul Kim;Rifat Mannan;James L. Lin;Yuman Fong;Yanghee Woo
    • Journal of Gastric Cancer
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    • v.24 no.3
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    • pp.267-279
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    • 2024
  • Purpose: The optimal treatment for gastroesophageal junction adenocarcinoma (GEJA) remains controversial. We evaluated the treatment patterns and outcomes of patients with locally advanced GEJA according to the histological type. Materials and Methods: We conducted a single-institution retrospective cohort study of patients with locally advanced GEJA who underwent curative-intent surgical resection between 2010 and 2020. Perioperative therapies as well as clinicopathologic, surgical, and survival data were collected. The results of endoscopy and histopathological examinations were assessed for Siewert and Lauren classifications. Results: Among the 58 patients included in this study, 44 (76%) were clinical stage III, and all received neoadjuvant therapy (72% chemoradiation, 41% chemotherapy, 14% both chemoradiation and chemotherapy). Tumor locations were evenly distributed by Siewert Classification (33% Siewert-I, 40% Siewert-II, and 28% Siewert-III). Esophagogastrectomy (EG) was performed for 47 (81%) patients and total gastrectomy (TG) for 11 (19%) patients. All TG patients received D2 lymphadenectomy compared to 10 (21%) EG patients. Histopathological examination showed the presence of 64% intestinal-type and 36% diffuse-type histology. The frequencies of diffuse-type histology were similar among Siewert groups (37% Siewert-I, 36% Siewert-II, and 33% Siewert-III). Regardless of Siewert type and compared to intestinal-type, diffuse histology was associated with increased intraabdominal recurrence rates (P=0.03) and decreased overall survival (hazard ratio, 2.33; P=0.02). With a median follow-up of 31.2 months, 29 (50%) patients had a recurrence, and the median overall survival was 50.5 months. Conclusions: Present in equal proportions among Siewert types of esophageal and gastric cancer, a diffuse-type histology was associated with high intraabdominal recurrence rates and poor survival. Histopathological evaluation should be considered in addition to anatomic location in the determination of multimodal GEJA treatment strategies.

Surgical Option for Sufficient Safety Margine in Locally Advanced Type II Cardia Cancer - Left Colon Interposition (국소 진행된 Type II 분문부 선암의 절제연 확보를 위한 수술 방법: 좌측 대장 간치술)

  • Yoon, Ho Young;Kim, Hyoung-Il;Lee, Sang Hoon;Kim, Choong Bai
    • Journal of Gastric Cancer
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    • v.8 no.2
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    • pp.97-103
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    • 2008
  • Purpose: Radical surgery is the standard therapy for patients with resectable cardia cancer. In the case of type II disease with esophageal invasion, a transhiatal extended radical total gastrectomy is needed or a gastroesophagectomy through an abdomino-thoracotomy, depending on the extent of the esophageal invasion. We analyzed the indications and outcome of left colon interposition as an esophageal substitution. Materials and Methods: Between 1 January 1994 and 31 December 2006, 10 patients underwent left colon interposition after gastroesophagectomy through an abdomino-thoracotomy or the tanshiatal approach for type II cardia cancer at the Department of surgery, Yonsei University College of Medicine. The outcomes of these patients were reviewed and compared, with those who underwent a Roux-en-Y, by gender and age matched analysis, retrospectively. Results: There were nine males and one female with a mean age of 52.5 (range, 16~72). The operation time was $449.00{\pm}87.39minutes$. The mean distance between the proximal resection margin and the cancer was $6.56{\pm}3.65cm$; the maximum size of the tumor was $9.90{\pm}3.97cm$. These measures differed significantly from patients who underwent Roux-en-Y. The patients had a double primary cancer in the cardia and esophagus. There were no events of colon necrosis. However, a pneumothorax occurred in one patient (10%) and a proximal anastomotic stricture occurred in one patient. There were no reports of heartburn, regurgitation, thoracic or epigastric fullness, and one patient even gained weight, 16 kg. Conclusion: Colon interposition after esophagogastrectomy was safe and effective and should be considered as an additional surgical option for locally advanced type II cardia cancer patients with esophageal invasion.

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