European Journal of Cardio-Thoracic Surgery, Vol 3, 99-103, Copyright © 1989 by European Association for Cardio-thoracic Surgery
Experience of partial oesophagectomy in surgical treatment of lower and middle thoracic oesophageal cancer. From a follow-up of 366 cases
L Couraud, JF Velly, P Clerc and C Martigne
Thoracic Surgery Unit, Xavier Arnozan Hospital, Bordeaux II University, Pessac, France.
Since carcinoma of the oesophagus is considered to be frequently
multicentric, total oesophagectomy appears the only radical therapeutical
approach. A follow-up of 366 patients who underwent partial oesophagectomy
shows that this procedure can be curative as well as palliative and is
sometimes the only procedure possible with a reasonable mortality. These
patients had an oesophageal carcinoma located between the cardia and the
level of the aortic arch (60.5% squamous, 37% adenocarcinoma). Of these,
22% were over 70 years of age. The surgical route was a left thoracotomy in
280 cases (with anastomosis below or above the aortic arch) or a laparotomy
and right thoracotomy in 86 cases. The oesophagus was transected as high as
possible and replaced by an isoperistaltic tube fashioned from the greater
curvature of the stomach. Mediastinal tissues and the lesser curvature with
their lymph nodes were removed. The overall operative mortality was 7% (4%
in patients less than 70 and 15% over 70). Very few anastomotic fistulae
were observed (6 cases) but they were always severe (6 deaths). The middle
and long term results show acceptable functional sequelae and a good
survival quality. The survival is 57% at 1 year, 30% at 3 years and 23% at
5 years (27% when the excision appeared curative). There was no significant
difference in survival for patients whose cancer was in the mid-oesophagus
compared to the lower oesophagus. There was no difference in survival in
the cell type squamous or adenocarcinoma. Death was mainly due to
metastatic lesions and mediastinal lymphatic recurrence.(ABSTRACT TRUNCATED
AT 250 WORDS)
