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 % (p_log-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.