Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2014 Vol. 22 No 4

ONCOLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.4.463   |  

V.T. MALKEVICH, I.A. ILYIN

THE COMPARATIVE ASSESSMENT OF VARIOUS METHODS OF RECONSTRUCTIVE ESOPHAGOCOLOPLASTY AT ESOPHAGEAL AND GASTROESOPHAGEAL CANCER

SE "N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology "
insk,
The Republic of Belarus

Objectives. To assess the efficacy of prevention complex of ischemic complications in esophageal reconstruction by esophagocoloplasty in patients with esophageal and gastroesophageal cancer.
Methods. In the Republican Scientific Practical Center of Oncology and Medical Radiology named by N.N. Alexandrov in the department of thoracic oncopathology the delayed esophagocoloplasty has been produced for 41 patients after radical surgeries due to the esophageal and gastroesophageal cancer (primary disconnection and induced disconnection surgeries due to the primary plastic complications) in the period from 2007 to 2013 yrs. This cohort was divided into 2 groups: control (n=21) group and the main (n=20) one.
In the control group the patients have been operated by performing a conventional plasty, in the main group by applying the developed prevention complex of ischemic complications: graft vascularization by transposition of the mesenteric colon vessels to the internal thoracic vessels, formation of the modified end-to-end esophagus-colon anastomosis, the elimination of osseous (resection of the xiphoid process of the sternum) and muscular (left-sided wide dissection of the anterior straight muscles of the neck) compression factors to the graft in retrosternal tunnel formation.
Results. In analyzing the structure of post-operative surgical complications it was found out that the use of prevention complex of ischemic complications permits to reduce significantly the frequency of postoperative complications in 3,8-folds from 57,1% up to 15% (p=0,006). Thus, the frequency of ischemic complications reduced in 6,6-folds from 33,3% to 5% (p=0,024). Analysis of the logistic regression model shows that the developed prevention complex of ischemic complications reduces reliably (p=0,045) a proportional risk of specific ischemic complications (graft necrosis and/or esophageal-colon anastomotic leakage) in 9,5-folds.
Conclusions. Applying the prevention complex of ischemic complications in delayed esophagocoloplasty performing allows improving of the immediate results of treatment in patients undergoing radical operation for esophageal and gastroesophageal cancer.

Keywords: esophagoplasty, esophagocoloplasty, two-stage operation, esophageal cancer, gastroesophageal cancer
p. 463 469 of the original issue
References
  1. Shah SV, Chheda YP, Pillai SK, Shah SV.Total oesophagectomy for squamous cell carcinoma with or without standard two field node dissection - a prospective study. Indian J Surg Oncol. 2013 Dec;4(4):33640.
  2. Li CL, Zhang FL, Wang YD, Han C, Sun GG, Liu Q, Cheng YJ, Jing SW, Yang CR. Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer. Oncol Lett. 2013 Jan;5(1):355359.
  3. Vijayakumar M, Burrah R, Hari K, Veerendra KV, Krishnamurthy S.Esophagectomy for cancer of the esophagus. A regional cancer centre experience. Indian J Surg Oncol. 2013 Dec;4(4):33235.
  4. Dunn DH, Johnson EM, Morphew JA, Dilworth HP, Krueger JL, Banerji N.Robot-assisted transhiatal esophagectomy: a 3-year single-center experience. Dis Esophagus. 2013 Feb-Mar;26(2):15966.
  5. Gutschow CA, Holscher AH, Leers J, Fuchs H, Bludau M, Prenzel KL, Bollschweiler E, Schroder W. Health-related quality of life after Ivor Lewis esophagectomy. Langenbecks Arch Surg. 2013 Feb;398(2):23137.
  6. Wright CD, Kucharczuk JC, O'Brien SM, Grab JD, Allen MS; Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009 Mar;137(3):58795.
  7. Aminian A, Panahi N, Mirsharifi R, Karimian F, Meysamie A, Khorgami Z, Alibakhshi A. Predictors and outcome of cervical anastomotic leakage after esophageal cancer surgery. J Cancer Res Ther. 2011 Oct-Dec;7(4):44853.
  8. Kassis ES, Kosinski AS, Ross P Jr, Koppes KE, Donahue JM, Daniel VC. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg. 2013 Dec;96(6):191926.
  9. Morita M, Nakanoko T, Kubo N, Fujinaka Y, Ikeda K, Egashira A, Saeki H, Uchiyama H, Ohga T, Kakeji Y, Shirabe K, Ikeda T, Tsujitani S, Maehara Y. Two-stage operation for high-risk patients with thoracic esophageal cancer: an old operation revisited. Ann Surg Oncol. 2011 Sep;18(9):261321.
  10. Okumura Y, Mori K, Yamagata Y, Fukuda T, Wada I, Shimizu N, Nomura S, Iida T, Mihara M, Seto Y. A two-stage operation for thoracic esophageal cancer: esophagectomy and subsequent reconstruction by a free jejunal flap. Surg Today. 2014 Feb;44(2):39598.
  11. Vorobei AV, Chepik DA, Vizhinis EI., Lur'e VN. Klinicheskoe obosnovanie odnoetapnoi zagrudinnoi ezofagokoloplastiki v lechenii bol'nykh s posleozhegovoi rubtsovoi strikturoi pishchevoda [The clinical substantiation of single-stage substernal esophagocoloplasty in treating patients with after burn esophageal scar stricture]. Meditsina. 2009;(4):5256.
  12. Uchiyama H, Morita M, Toh Y, Saeki H, Kakeji Y, Matsuura H, Maehara Y. Superdrainage of the ileocolic vein to the internal jugular vein interposed by an inferior mesenteric vein graft in replacing the esophagus with the right hemicolon. Surg Today. 2010 Jun;40(6):57882.
  13. Awsakulsutthi S.Result of esophageal reconstruction using supercharged interposition colon in corrosive and Boehave's injury: Thammasat University Hospital experience. J Med Assoc Thai. 2010 Dec;93 Suppl 7:S303-6.
  14. Averin V, Podgaiskii VN, Nesteruk LN, Grinevich IuM, Ryliuk AF. Pervyi opyt revaskuliarizatsii transplantata pri plastike pishchevoda u detei v nestandartnykh situatsiiakh [The first experience of graft revascularization in esophagoplasty children in unusual situations]. Novosti Khirurgii. 2012;20(1):8084.
  15. Kesler KA, Pillai ST, Birdas TJ, Rieger KM, Okereke IC, Ceppa D, Socas J, Starnes SL. "Supercharged" isoperistaltic colon interposition for long-segment esophageal reconstruction. Ann Thorac Surg. 2013 Apr;95(4):116268.
Address for correspondence:
223040, Respublika Belarus, Minskaya oblast, Minskiy rayon, agrogorodok Lesnoy 2, GU "RNPTs onkologii i meditsinskoy radiologii im. N.N. Aleksandrova", otdel torakalnoy onkopatologii s gruppoy anesteziologii,
e-mail: ileus@tut.by,
Ilin Ilya Anatolevich
Information about the authors:
Malkevich V.T. MD, a chief researcher of the thoracic oncopathology department with the anesthesiology group of SE N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology.
Ilyin I.A. A full-time post-graduate student, SE N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology.
Contacts | ©Vitebsk State Medical University, 2007