SIX MONTHS FOLLOW UP STUDY OF TWO HUNDRED CASES OF TRANSTHORACIC OESOPHAGECTOMY

Abstract

Objective: To evaluate the outcome of oesophagectomy with feeding jejunostomy and no gastric drainage

procedure, during 6 months of follow up.

Material and Methods: This observational descriptive study was conducted at department of

cardiothoracic surgery, Lady Reading Hospital Peshawar. Computerized clinical data of 200 surgically

treated patients with post-op adjuvant therapy from July 2005 to June 2002 was retrospectively analyzed.

Detailed scrutiny of record was carried out to determine the suitability and safety of the surgical

procedure and surgical outcome.

Results: A total of 200 patients (males 130, females 70) with a mean age of 42.3 years underwent

oesophagectomy. Histology showed squamous cell carcinoma in 66.6% and adenocarcinoma in 33.3%

patients. Postoperative morbidity was 16.5 % (33/200). The main complications of oesophagectomy were

anastomotic leak in 12(6%), aspiration in 9(4.5%) and hoarseness in 8(4%) patients. The one-month

postoperative mortality was 9% (18/200). Deaths were due to tracheal injury in 6(3%), pulmonary

embolism in 5(2.5%), anastomotic leak in 4(2%) and respiratory failure in 3(1.5%) patients. At 6 months

follow up, 46 patients (23%) were lost to follow-up and morbidity was 7.8% (12/154). Recurrence occurred

in 7 (4.5%) cases; 3 patients had stricture and one each had hoarseness and incisional hernia.

Conclusion: Left thoracolaparotomy and cervical anastomosis is a safe approach for carcinoma of the

esophagus. Omitting a gastric drainage procedure does not adversely affect the outcome. Routine

placement of a jejunostomy feeding catheter is a safe and cost effective mode of nutrition.