REPEATED AND DELAYED ESOPHAGOPLASTY IN ESOPHAGEAL AND GASTROESOPHAGEAL CANCER TREATMENT
Abstract
The аim of the study was to develop a method of repeated and delayed esophageal reconstruction after incomplete esophageal replacement for patients with esophageal and gastroesophageal carcinomas. From 2010 to 2015 at the N.N. Alexandrov National Cancer Centre of Belarus 41 patients underwent repeated (n = 29) and delayed (n = 12) esophageal replacement by colon interposition after radical surgery for esophageal and gastroesophageal carcinomas after incomplete esophagoplasty. To evaluate the technology effectiveness, all patients were divided into two groups – control (n = 21) and main (n = 20) ones. In the control group esophageal reconstruction was performed by the previously used procedure, in the main group – by the developed method with vascular augmentation of the graft by the vascular anastomosis formation between colonic and internal thoracic vessels. The use of a new method of esophageal reconstruction has reduced the overall incidence of postoperative complications (from 57.1 to 15.0 %, p = 0.006) mainly due to decreasing the incidence of ischemic complications (from 33.3 to 5.0 %, p = 0.024). The method of reconstruction has allowed one to increase the overall survival: 1-year – with 43.2 ± 11.4 to 66.7 ± 11.4 %, and 3-year – with 21.6 ± 10.5 to 34.3 ± 13.2 % (plog-rank = 0.350). At the same time, the median survival increased from 6.0 ± 1.0 months to 16.0 ± 1.5 months. Additional blood supply to the graft has reduced the incidence of esophageal anastomotic scar stricture from 28.6 to 5.0 % (p = 0.048). The new method of esophageal reconstruction can improve the immediate and long-term results of plastic in patients suffering from esophageal and gastroesophageal carcinomas after surgery with incomplete esophagoplasty without affecting the frequency and structure of postoperative complications, in-hospital and 30-day mortality.
About the Authors
I. A, Ilyin
N. N. Alexandrov National Cancer Centre of Belarus
Belarus
Belarus
V. T. Malkevich
N. N. Alexandrov National Cancer Centre of Belarus
Belarus
Belarus
References
1. Total oesophagectomy for squamous cell carcinoma with or without standard two field node dissec tion – a prospective study / S. V. Shah [et al.] // Indian J. Surg. Oncol. – 2013. – Vol. 4, N 4. – P. 336–340.
2. Characteristics of recurrence after radical esophagectomy with two-field lymph node dissection for thoracic esophageal cancer / C. L. Li [et al.] // Oncol. Lett. – 2013. – Vol. 5, N 1. – P. 355–359.
3. Esophagectomy for cancer of the esophagus. A regional cancer centre experience / M. Vijayakumar [et al.] // Indian J. Surg. Oncol. – 2013. − Vol. 4, N 4. – P. 332–335.
4. Application of colonic interposition in the digestive tract reconstruction after esophagectomy / L. Peng [et al.] // Zhonghua Wei Chang Wai Ke Za Zhi. – 2011. – Vol. 14, N 9. – P. 695–698.
5. Клиническое обоснование одноэтапной загрудинной эзофагоколопластики в лечении больных с послеожоговой рубцовой стриктурой пищевода / А. В. Воробей [и др.] // Медицина. – 2009. – № 4. – С. 52–56.
6. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model / C. D. Wright [et al.] // J. Thorac. Cardiovasc. Surg. – 2009. – Vol. 137, N 3. – P. 587–595.
7. Predictors and outcome of cervical anastomotic leakage after esophageal cancer surgery / A. Aminian [et al.] // J. Cancer Res. Ther. – 2011. – Vol. 7, N 4. – P. 448−453.
8. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database / E. S. Kassis [et al.] // Ann. Thorac. Surg. – 2013. – Vol. 96, N 6. – P. 1919–1926.
9. Two-stage operation for high-risk patients with thoracic esophageal cancer: an old operation revisited / M. Morita [et al.] // Ann. Surg. Oncol. – 2011. – Vol. 18, N 9. – P. 2613–2621.
10. Новые подходы к лечению внутриплевральных осложнений в хирургии рака пищевода / В. Т. Малькевич [и др.] // Новости хирургии. – 2012. – Т. 20, № 3. – С. 74–80.
11. Ильин, И. А. Экспериментально-клиническое обоснование комплекса противоишемических мероприятий при эзофагоколопластике / И. А. Ильин, В. Т. Малькевич // Онкол. журн. – 2014. – Т. 8, № 2. – С. 35–43.
12. Expanding the applications of microvascular surgical techniques to digestive surgeries: a technical review / H. Uchiyama [et al.] // Surg. Today. – 2012. – Vol. 42, N 2. – P. 111–120.
13. Awsakulsutthi, S. Result of esophageal reconstruction using supercharged interposition colon in corrosive and Boe-have’s injury: Thammasat University Hospital experience / S. Awsakulsutthi // J. Med. Assoc. Thai. – 2010. – Vol. 93, N 7. – P. 303–306.
14. Чакиев, А. М. Возможность применения микрохирургических сосудистых анастомозов при эзофагопластике / А. М. Чакиев // Вестн. Кыргыз.-Рос. Славян. ун-та. – 2008. – Т. 8, № 5. – С. 23–25.
15. “Supercharged” isoperistaltic colon interposition for long-segment esophageal reconstruction / K. A. Kesler [et al.] // Ann. Thorac. Surg. – 2013. – Vol. 95, N 4. – P. 1162–1168.
Review
For citations:
Ilyin I.A., Malkevich V.T. REPEATED AND DELAYED ESOPHAGOPLASTY IN ESOPHAGEAL AND GASTROESOPHAGEAL CANCER TREATMENT. Proceedings of the National Academy of Sciences of Belarus, Medical series. 2016;(2):15-22. (In Russ.)
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