Complications of esophageal cancer surgery and treatment

Year 2012, Volume: 29 Issue: 4S, 237 - 242, 07.05.2013

Murat Özkan , İlker Ökten

https://doi.org/10.5835/jecm.omu.29.s4.008

Abstract

Morbidity rate associated with surgical treatment of esophageal cancer is still high, although it is significantly decreased in recent years according to improvements and developments in patient selection, surgical technique and perioperative approach. Respiratory failure, sepsis, anastomotic leakage, esophageal stricture, fistula, reflux, obstruction, bleeding, chylothorax, pneumothorax, pancreatitis and splenic injuries are major complications of esophageal cancer surgery. Respiratory physiotherapy and pain control are two key approaches in prevention of pulmonary complications. Anastomotic leakage is a significant complication with high morbidity and mortality rate. Esophageal stricture occurs in 30-50% of cases in the first three months, postoperatively. It is often treated with repeated dilatations. Mortality is inevitable for the development of fistula between airways and the trachea, if it is left untreated. Despite its high morbidity and mortality rates, surgical treatment is the main treatment modality of esophageal cancer.

Keywords

Esophageal cancer, Resection, Esophagectomy, Anastomosis, Complication, Morbidity

Özofagus kanseri cerrahisinde komplikasyonlar ve tedavisi

Abstract

Özofagus kanserinin cerrahi tedavisi ile ilişkili morbidite oranı hasta seçimi, cerrahi teknik ve perioperatif yaklaşımdaki iyileşme ve gelişmeler nedeniyle son yıllarda belirgin derecede düşmüş olmasına rağmen hala yüksektir. Solunum yetmezliği, sepsis, anastomoz kaçağı, özofageal striktür, fistül, reflü, obstrüksiyon, kanama, şilotoraks, pnömotoraks, pankreatit ve dalak yaralanması özofagus kanseri cerrahisinde karşılaşılan başlıca komplikasyonlardır. Solunum fizyoterapisi ve ağrı kontrolü pulmoner komplikasyonların önlenmesinde anahtar iki yaklaşımdır. Anastomoz kaçağı yüksek morbidite ve mortalite oranı ile önemli bir komplikasyondur. Özofageal striktür postoperatif ilk 3 ayda 30-50% olguda görülür. Çoğunlukla tekrar eden dilatasyonlarla tedavi edilir. Hava yolları ve özofagus arasında fistül gelişimi tedavi edilmez ise mortalitenin kaçınılmaz olduğu bir komplikasyondur. Yüksek morbidite ve mortalite oranlarına rağmen özofagus kanserinde cerrahi tedavi esas tedavi yöntemidir.

Keywords

Özofagus kanseri, Rezeksiyon, Özofajektomi, Anastomoz, Komplikasyon, Morbidite

References

• Akiyama, H., Hiyama, M.A., 1974. Simple esophageal bypass operation by the high gastric division. Surgery. 75, 674-681.
• Angorn, I.B., 1975. Oesophagogastrectomy without a drainage procedure in esophageal carcinoma. Br. J. Surg. 62, 601-604.
• Cheung, H.C., Siu, K.F., Wong, J., 1987. Is pyloroplasty necessary in esophageal replacement by stomach? A prospective randomized controlled trial. Surgery. 102, 19-24.
• Cioffiro, W., Schein, C.J., Gliedmann, M.L., 1976. Splenic injury during abdominal surgery. Arch. Surg. 111, 167-171.
• Danforth, D.N., Thorbjarnarson, B., 1976. Incidental splenectomy: A review of the literature and the New York hospital experience. Ann. Surg. 183, 124-129.
• Dewar, L., Gelfand, G., Finley, R.J., Evans, K., Inculet, R., Nelems, B., 1992. Factors affecting cervical anastomotic leak and stricture formation follow esophagogastrectomy and gastric tupe interposition. Am. J. Surg. 163, 484-489.
• Ferguson, M.K., Little, A.G., Skinner, D.B., 1985. Current concepts in the management of postoperative chylothorax. Ann. Thorac. Surg. 40, 542-545.
• Fok, M., Ah-Chong, A.K., Cheng, S.W., Wong, J., 1991. Comparison of a single layer continuous hand sewn method and circular stapling in 580 esophageal anastomoses. Br. J. Surg. 78, 342-345.
• Fok, M., Cheng, S.W., Wong, J., 1991. Pyloroplasty versus no drainage in gastric replacement of the esophagus. Am. J. Surg. 162, 447-452.
• Holscher, A.H., Voit, H., Buttermann, G., Siewert, J.R., 1988. Function of the intrathoracic stomach as esophageal replacement. World J. Surg. 12, 835-844.
• Huang, G.J., Zhang, D.C., Zhang, D.W., 1985. A comparative study of resection of carcinoma of the esophagus with and without pyloroplasty. In: DeMeester, T.R., Skinner, D.B., eds. Esophageal disorders: Pathophysiology and therapy. New York. Raven Pres. 383.
• Iannettoni, M.D., Whyte, R.I., Orringer, M.B., 1995. Catastrophic complications of the cervical esophagogastric anastomosis. J. Thorac. Cardiov. Sur. 110, 1493-1500.
• Katariya, K., Harvey, J.C., Pina, E., Beattie, E.J., 1994. Complications of transhiatal esophagectomy. J. Surg. Oncal. 57, 157-163.
• Kirsch, M., Blue, M., Desai, R.K., Sivak, M.V. Jr., 1991. Intralesional steroid injections for peptic esophageal strictures. Gastrointest. Endosc. 37, 180-182.
• Kron, I.L., Johnson, A.M., Morgan, R.F., 1989. Gastrotracheal fistula: A late complication after transhiatal esophagectomy. Ann. Thorac. Surg. 47, 767-768.
• Lam, K.H., Lim, S.T., Wong, J., Ong, G.B., 1979. Chylothorax following resection of the oesophagus. Br. J. Surg. 66, 105-109.
• Muller, J.M., Erasmi, H., Stelzner, M., Zieren, U., Pichlmaier, H., 1990. Surgical therapy of carcinoma. Br. J. Surg. 77, 845-857.
• Olsen, W.R., Beaudoin, D.E., 1970. Surgical injury to the spleen. Surg. Gynecol. Obstet. 131, 57-62.
• Orringer, M.B., Bluett, M., Deep, G.M., 1988. Agressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy. Surgery. 104, 720-726.
• Orringer, M., Marshall, B., Iannettoni, M.D., 2000. Eliminating the cervical esophagogastric leak with a side-to-side stapled anastomasis. J. Thorac. Cardiov. Sur. 119, 277-288.
• Ökten, İ., 1982. İntratorasik yerleştirilmiş vagatomize midede mide boşalmasının incelenmesi. Ankara Tıp Bülteni. 4, 83-87.
• Postlethwait, R., 1983. Complications and deaths after operations for esophageal carcinoma. J. Thorac. Cardiov. Sur. 85, 827-831.
• Shahian, D., Neptune, W., Ellis, F.H., Watkins, E. Jr., 1986. Transthoracic versus extrathoracic esophagectomy: Mortality, morbitidy and longterm survival. Ann. Thorac. Surg. 41, 237-246.
• Shapiro, S., Hamlin, D., Morgenstern, L., 1972. The fate of the pylorus in esophagogastrectomy. Surg. Gynecol. Obstet. 135, 216-218.
• Vigneswaran, W.T., Trastek, V.F., Pairolero, P.C., Deschamps, C., Daly, R.C., Allen, M.S., 1993. Transhiatal esophagectomy for carcinoma of the esophagus. Ann. Thorac. Surg. 56, 836.