Esophagectomy complications and mortality in esophageal cancer patients, a comparison between trans-thoracic and trans-hiatal methods
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Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
Department of Surgery, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
Online publication date: 2018-08-07
Publication date: 2019-04-22
Electron J Gen Med 2019;16(2):em127
Esophageal cancer is the sixth cause of cancer related deaths worldwide. Esophagectomy is the standard treatment for non-metastatic esophageal cancer, but is associated with high mortality and morbidity rates. We evaluated the mortality and complications following esophagectomy, and factors affecting it (including the surgical approach).

This retrospective study was performed from 2006 to 2012; the data were collected from medical files of esophageal cancer patients who underwent surgical procedures at Iran’s cancer institute and analyzed.

A total of 254 operated esophageal cancer patients entered this study. Patients included 105 males and 149 females, with a mean age of 65.70. Of all the operated patients, 121 (47.64%) underwent the trans-hiatal and 121 (47.64%) the transthoracic esophagectomy method, also 12 patients were operated by other surgical methods. Post-operative complications occurred in 61 patients (24.02%). Respiratory complications (20.08%) –including Adults Respiratory Distress Syndrome (9.45 %), pneumonia (6.30%) and ventilator dependency (4.33%) - were the most common complications. Other major complications were anastomosis leakage and fistula (6.30 %), atrial fibrillation (6.30 %), chylothorax (3.15%), bleeding requiring reoperation (1.97%) and pulmonary embolism (1.97 %). In-hospital mortality rate was 5.12 %. Pneumonia, ICU admission and intubation time were significantly higher in transthoracic than trans-hiatal method but mortality was not significantly different. ARDS, ventilator dependency and history of cardio-pulmonary disease were prognostic for in-hospital mortality.

Although esophagectomy is a complex surgery and associated with multiple complications, in case of proper patient selection and experienced surgeons, both the transthoracic and trans-hiatal esophagectomy methods have appropriate results.

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