This journal is
indexed in Scopus
Year 2012 Vol. 20 No 3
V.T. MALKEVICH, V.V. ZHARKOV, L.I. OSITROVA, V.P. KURCHIN, A.YU. BARANOV, I.A. ILYIN
NEW APPROACHES TO TREATMENT OF INTRAPLEURAL COMPLICATIONS IN ESOPHAGEAL CANCER SURGERY
SE “N.N.Alexandrov Republican Scientific Practical Center of Oncology and Radiology”, Minsk
The Republic of Belarus
Objectives. To work out and introduce in the clinical practice a new treatment method of the intrapleural complications caused by anastomosis sutures failure and/or esophagotransplant necrosis at surgical treatment of the esophageal cancer.
Methods. The paper presents the surgical treatment experience of 59 patients on the basis of the thoracic department of N.N.Alexandrov Republican scientific practical center of oncology and radiology, in whom, after surgical treatment for esophageal cancer, intrapleural complications developed: esophageal anastomotic sutures failure was diagnosed in 17 and esophagotransplant necrosis – in 42 patients.
Results. The conservative principle was used in 22 patients (the 1 group) with saving of the esophagogastric anastomosis; and 37 patients (the 2 group) were treated by active surgical tactics based on the disconnecting surgery with the resection of the proximal segment of gastric stem with the esophageal anastomotic segment and esophagostomy, gastro- or jejunostomy formation. In 6 patients from the 2 group, treatment of intrapleural complications was carried out using a new method by anastomotic esophageal segment and proximal gastric area apparatus resection within healthy tissue boundaries with the leaving of the resected stump in the posterior mediastinum, the formation of the cervical end esophagostomy in the left supraclavicular area and the suspended probe jejunostomy in the left mesogaster.
Conclusions. It was established that the optimal treatment method of esophagotransplant necrosis and/or esophageal anastomosis sutures failure was the active surgical tactics aimed “to disconnect” the alimentary tract continuity, allowing to reduce postoperative mortality and to provide the potential long-term survival rates for this group of patients by performing the reconstructive surgery.
1. Davydov MI, Polotskii BE, Stilidi IS. Rak pishchevoda: sovremennye podkhody k diagnostike i lecheniiu. [Esophageal cancer: current approaches to diagnosis and treatment]. Rus Med Zhur. 2006;14(14):1006–15.
2. Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000 Aug;232(2):225–32.
3. Dowson HM, Strauss D, Ng R, Mason R. The acute management and surgical reconstruction following failed esophagectomy in malignant disease of the esophagus. Dis Esophagus. 2007;20(2):135–40.
4. Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg. 2005 Jan;27(1):3–7.
5. Siewert JR, Bottcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. 1998 Oct;228(4):449–61.
6. Bardini R, Bonavina L, Asolati M, Ruol A, Castoro C, Tiso E. Single-layered cervical esophageal anastomoses: A prospective study of two suturing techniques. 1994 Oct;58(4):1087–89; discussion 1089–90.
7.Cassivi SD. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg. 2004;169(2):124–32.
8. Jacobi CA, Zieren HU, Zieren J, Muller JM. Is tissue oxygen tension during esophagectomy a predictor of esophagogastric anastomotic healing? J Surg Res. 1998 Feb 1;74(2):161–64.
9. Peracchia A, Bardini R, Ruol A, Asolati M, Scibetta D. Esophagovisceral anastomotic leak: a prospective statistical study of predisposing factors. J Thorac Cardiovasc Surg. 1988 Apr;95(4):685–91.
10. Sharma D. Esophageal replacement by gastric transposition. IJS. 2000;62:97–12.
11. Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001 Mar;233(3):338–44.
12. Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux P, van Raemdonck D. Anastomotic ñomplications after esophagectomy. Dig Surg. 2002;19(2):92–8.
13. Mal'kevich VT, Bogushevich EV, Ositrova LI, Serova TN, Il'in IA. Rentgenodiagnostika vnutriplevral'nykh oslozhnenii posle khirurgicheskogo lecheniia po povodu raka pishchevoda i kardii. [X-ray diagnosis of intrapleural complications after esophageal and cardia cancer surgery]. Novosti Khirurgii. 2011;19(6):95–100.
14. Davydov MI, Stilidi S. Rak pishchevoda. [Cancer of the esophagus]. Moscow, RF: Izdat. gruppa RONTs, Prakt meditsina; 2007. 392 p.
223040, Respublika Belarus', Minskaia obl., Minskii raion, pos. Lesnoi 2, ÃÓ “RNPTs onkologii i meditsinskoi radiologii im. N.N. Aleksandrova“, otdel torakal'noi onkopatologii,
Mal'kevich Viktor Tikhonovich
Malkevich V.T., Candidate of Medical Sciences, Senior Research Fellow, Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Zharkov V.V., Doctor of Medical Sciences, Professor, Chief Research Fellow, Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Ositrova L.I., Candidate of Medical Sciences, Oncologist-Surgeon of the Oncological Thoracic Department ¹ 1 of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Kurchin V.P., Doctor of Medical Sciences, Head of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Baranov A.Yu., Head of the Oncological Thoracic Department ¹ 1 of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Ilyin I.A., a Clinical Resident of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.