Original Article
Analysis of postoperative outcomes for surgically resected esophageal squamous cell carcinoma reconstructed with gastric conduit
Abstract
Background: To investigate the postoperative outcomes and complication management results after esophagectomy with gastric conduit reconstruction for esophageal squamous cell carcinomas.
Methods: The medical records of patients with esophageal squamous cell carcinoma who underwent esophagectomy and gastric conduit reconstruction in a single institute by a single surgeon (Dr. Jheon) between 2003 and 2013 were retrospectively reviewed. Patients who underwent transhiatal esophagectomy or simultaneous hypopharyngeal cancer operation were excluded. Postoperative outcomes including complication management were investigated, and survival analysis was performed.
Results: A total of 105 patients were enrolled in this study. Mean follow-up period was 47.5±33.98 (range, 1.7 to 126.7) months, mean age was 64.0±8.81 (range, 24 to 84) years, and mean hospital stay was 15.2±12.6 (range, 9 to 96) days. Perioperative complication rate was 24.8%, and the incidence of esophageal stenosis was 13.3%. The most commonly observed perioperative complication was vocal cord palsy, which occurred in 14 patients (13.3%). Pneumonia occurred in 4 patients (3.8%), and one developed into acute respiratory distress syndrome (ARDS). Wound problems were observed in 8 patients (7.6%), and half of them (4 patients) required surgical intervention. Incidence of anastomotic leak was 2.9% (3 patients), and only one patient required surgical intervention. Overall 3- and 5-year survival rates were 65.2% and 57.9%, respectively. Overall 3- and 5-year recurrence-free survival rates were 64.0% and 55.6%, respectively. A total of 42 patients died during the follow-up period; however, no postoperative mortality (within 30 days after surgery) was observed. Complication-related death was observed in 2 cases (fistula bleeding and aspiration pneumonia). Twenty-four patients died of cancer progression, 6 patients died of pneumonia, and the other deaths were not related to cancer or complications. Anastomotic leak was related with significantly lower overall and recurrence-free survival (P<0.000 and P=0.030, respectively). Recurrent laryngeal nerve palsy was related to shorter overall survival but not to recurrence-free survival (P=0.032 and P=0.282, respectively). The occurrence of esophageal stenosis was not significantly related to shorter overall survival or recurrence free survival (P=0.057 and P=0.218, respectively).
Conclusions: Esophagectomy combined with gastric conduit reconstruction is a safe and established surgical treatment for esophageal squamous cell carcinoma. Appropriately controlled postoperative complications may not affect postoperative outcomes. However, considerable complications such as anastomotic leak or recurrent laryngeal nerve palsy could influence long term survival.
Methods: The medical records of patients with esophageal squamous cell carcinoma who underwent esophagectomy and gastric conduit reconstruction in a single institute by a single surgeon (Dr. Jheon) between 2003 and 2013 were retrospectively reviewed. Patients who underwent transhiatal esophagectomy or simultaneous hypopharyngeal cancer operation were excluded. Postoperative outcomes including complication management were investigated, and survival analysis was performed.
Results: A total of 105 patients were enrolled in this study. Mean follow-up period was 47.5±33.98 (range, 1.7 to 126.7) months, mean age was 64.0±8.81 (range, 24 to 84) years, and mean hospital stay was 15.2±12.6 (range, 9 to 96) days. Perioperative complication rate was 24.8%, and the incidence of esophageal stenosis was 13.3%. The most commonly observed perioperative complication was vocal cord palsy, which occurred in 14 patients (13.3%). Pneumonia occurred in 4 patients (3.8%), and one developed into acute respiratory distress syndrome (ARDS). Wound problems were observed in 8 patients (7.6%), and half of them (4 patients) required surgical intervention. Incidence of anastomotic leak was 2.9% (3 patients), and only one patient required surgical intervention. Overall 3- and 5-year survival rates were 65.2% and 57.9%, respectively. Overall 3- and 5-year recurrence-free survival rates were 64.0% and 55.6%, respectively. A total of 42 patients died during the follow-up period; however, no postoperative mortality (within 30 days after surgery) was observed. Complication-related death was observed in 2 cases (fistula bleeding and aspiration pneumonia). Twenty-four patients died of cancer progression, 6 patients died of pneumonia, and the other deaths were not related to cancer or complications. Anastomotic leak was related with significantly lower overall and recurrence-free survival (P<0.000 and P=0.030, respectively). Recurrent laryngeal nerve palsy was related to shorter overall survival but not to recurrence-free survival (P=0.032 and P=0.282, respectively). The occurrence of esophageal stenosis was not significantly related to shorter overall survival or recurrence free survival (P=0.057 and P=0.218, respectively).
Conclusions: Esophagectomy combined with gastric conduit reconstruction is a safe and established surgical treatment for esophageal squamous cell carcinoma. Appropriately controlled postoperative complications may not affect postoperative outcomes. However, considerable complications such as anastomotic leak or recurrent laryngeal nerve palsy could influence long term survival.
