Pyloroplasty versus no drainage in gastric replacement of the esophagus

Article Abstract:

Because of the generally short survival of patients with esophageal cancer, even after successful surgery, it is desirable to have the patient recover quickly and regain normal eating habits as soon as possible. Frequently, the stomach is used as a substitute for the removed esophagus; this can give rise to obstruction of the pylorus, the outlet of the stomach into the intestine. Obstruction can be avoided if pyloroplasty (surgical enlargement of the pylorus) is performed at the time of esophagectomy; however, this procedure has its own potential complications and its use remains controversial. A prospective, randomized study was undertaken of 200 patients who underwent esophagectomy; 100 patients had pyloroplasty, and 100 did not. There were no deaths as a result of pyloroplasty. Symptoms of stomach outlet obstruction occurred in 13 patients who did not undergo this procedure. This complication required prolonged parenteral feeding and one patient required another operation. Pulmonary complications (pneumonia, aspiration pneumonia and respiratory failure) occurred in 16 of the pyloroplasty patients and 23 patients in the control group. Postoperative problems occurred in 24 pyloroplasty patients, and 39 control patients; this difference was significant. Two weeks after surgery, 65 percent of the pyloroplasty patients, compared with 41 percent of the controls, were able to eat solid food. Over time this difference disappeared; three years after surgery all patients were able to eat solid foods. The control group complained of more meal-related symptoms than did the pyloroplasty patients; this difference remained significant for six months. The authors recommend that pyloroplasty be performed when patients undergo esophagectomy and that the entire stomach be used for reconstruction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stomach diseases, Pylorus

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A comparison of transhiatal and transthoracic resection for carcinoma of the thoracic esophagus

Article Abstract:

The vast majority of patients who have esophageal cancer cannot be cured. The best palliative surgery (aimed at improving patient comfort) for patients with esophageal cancer is esophageal resection, removal of the involved segment of esophagus. This procedure is usually preformed by going into the chest cavity. It has been suggested that the same, if not better, palliative results can be achieved by approaching the esophagus from below, through the diaphragm (transhiatal) rather than the chest cavity. One institution performs both types of surgery, with the transhiatal approach being used for patients with relatively early or small esophageal tumors located within the chest cavity, or more advanced tumors in the upper or lower esophagus, as well as for patients for whom thoracic surgery is too risky. Out of 210 patients undergoing surgery for cancer of the lower and middle thirds of the esophagus, 38 patients were selected to undergo transhiatal approach, while 172 underwent thoracic approach. Excessive bleeding and tumor perforation occurred in seven of the transhiatal group (18 percent); five patients (13 percent) sustained nerve injury. Both groups had similar complication rates and mortality. Life-table analysis revealed that the transhiatal approach was inferior to the transthoracic approach. Survival was found to be better if the transthoracic approach was used. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Impact of transhiatal esophagectomy on cardiac and respiratory function

Article Abstract:

Surgical removal of the esophagus performed through the diaphragm avoids the complications involved in opening the chest cavity. However, this technique has a greater impact on respiratory and heart function than previously believed. A study was conducted on 44 patients who underwent transhiatal esophagectomy to determine the impact of surgery on heart and lung function. Thirty-seven patients underwent surgery because of esophageal cancer; seven patients had benign disease (esophageal perforation, narrowing or motility disorder). Prior to surgery, 31 patients had lung disease and 22 (of the 31) also had heart problems. Following surgery, all patients were treated in the intensive care unit; patients received an average of 49 hours of mechanical ventilation. Fourteen of the patients with a history of heart disease developed arrhythmias (abnormal heart rhythms); all were treated medically. Congestive heart failure developed in nine patients and all recovered. Five of the 44 patients died (11 percent); those who died were being treated for esophageal cancer. The average hospitalization for the survivors was 15 days. The data indicate that transhiatal esophagectomy can be performed safely on patients who have poor preoperative lung function; these patients make up about 10 percent of those needing esophagectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Postoperative complications, Lung diseases, Obstructive, Chronic obstructive lung disease

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