Esophageal Cancer: Surgical Strategies
Autor(a) principal: | |
---|---|
Data de Publicação: | 2014 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159 |
Resumo: | Introduction: Oesophagectomy for cancer is associated to a significant morbidity and mortality. The superiority of transthoracic vs transhiatal is still a matter of controversy. The aim of this paper is to discuss the results of a series of patients submitted to either a transthoracic or a transhiatal according to the anatomic location regarding the carina.Material and Methods: Retrospective analysis of 52 consecutive patients, with oesophageal carcinoma, 7 female and 45 males, median age 64 [46-85] years. Location: cervical – 1; above carina - 22; below or at carina level - 19; cardia type I –10. 19 adenocarcinoma, 32 squamous cells, 1 lymphoma. Twenty patients (40%) – neo-adjuvant therapy. Thoracoabdominal approach – 3, cervico-thoracoabdominal – 20, transhiatal – 27, exploratory thoracotomy – 2. Gastric pull-up 49 (cervical anastomosis – 46; thoracic - 3); cervical oesofagocoloplasty -1.Results: Pathologic staging: complete remission - 8; Ib – 3; IIa – 9; IIb - 4; IIa – 11; IIIb -2; IIIc – 10; IV – 1; non-stageable - 3. Major complications: 37%. Resectability: 96% (50/52). Mortality: 4th week - 6%; in-hospital - 14%. Median survival 18 months [3-80]. Survival Curves (Kaplan-Meier): 2 years - 47%; 5 years - 19% (transthoracic vs transhiatal p > 0.05).Discussion: Selection of surgical approach based on the anatomic location of the tumour regarding the carina was safe, the resectability was high and similar when a transthoracic or a transhiatal was planed and carry-on.Conclusions: In this series of oesophageal cancer patients, in advanced pathologic condition (52% p Stages III/IV) the overall survival was similar for transthoracic and transhiatal. Neo-adjuvant treatments definitively contributed to enhance resectability.Keywords: Esophagectomy; Laparoscopy; Esophageal Neoplasms/surgery; Thoracotomy. |
id |
RCAP_ee78c2a774b7e3dae9b9d2332a864580 |
---|---|
oai_identifier_str |
oai:ojs.www.actamedicaportuguesa.com:article/5159 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Esophageal Cancer: Surgical StrategiesCancro do Esófago: Estratégia de Abordagem CirúrgicaIntroduction: Oesophagectomy for cancer is associated to a significant morbidity and mortality. The superiority of transthoracic vs transhiatal is still a matter of controversy. The aim of this paper is to discuss the results of a series of patients submitted to either a transthoracic or a transhiatal according to the anatomic location regarding the carina.Material and Methods: Retrospective analysis of 52 consecutive patients, with oesophageal carcinoma, 7 female and 45 males, median age 64 [46-85] years. Location: cervical – 1; above carina - 22; below or at carina level - 19; cardia type I –10. 19 adenocarcinoma, 32 squamous cells, 1 lymphoma. Twenty patients (40%) – neo-adjuvant therapy. Thoracoabdominal approach – 3, cervico-thoracoabdominal – 20, transhiatal – 27, exploratory thoracotomy – 2. Gastric pull-up 49 (cervical anastomosis – 46; thoracic - 3); cervical oesofagocoloplasty -1.Results: Pathologic staging: complete remission - 8; Ib – 3; IIa – 9; IIb - 4; IIa – 11; IIIb -2; IIIc – 10; IV – 1; non-stageable - 3. Major complications: 37%. Resectability: 96% (50/52). Mortality: 4th week - 6%; in-hospital - 14%. Median survival 18 months [3-80]. Survival Curves (Kaplan-Meier): 2 years - 47%; 5 years - 19% (transthoracic vs transhiatal p > 0.05).Discussion: Selection of surgical approach based on the anatomic location of the tumour regarding the carina was safe, the resectability was high and similar when a transthoracic or a transhiatal was planed and carry-on.Conclusions: In this series of oesophageal cancer patients, in advanced pathologic condition (52% p Stages III/IV) the overall survival was similar for transthoracic and transhiatal. Neo-adjuvant treatments definitively contributed to enhance resectability.Keywords: Esophagectomy; Laparoscopy; Esophageal Neoplasms/surgery; Thoracotomy.Introdução: A ressecção transmediastínica e a ressecção transtorácica têm mortalidade hospitalar (1,4% -14%) e sobrevivência (± 25% aos cinco anos) semelhantes. A terapêutica neo-adjuvante é opção em estádios avançados. A intenção deste trabalho é apresentar uma série consecutiva de 52 doentes - opção operatória baseada na localização anatómica: tumores infra-carinais e cervicais submetidos a ressecção transmediastínica e restantes ressecções transtorácicas.Material e Métodos: O estudo incluiu 52 doentes consecutivos, sete mulheres e 45 homens, mediana de idade: 64 anos [46- 85]. Localização: cervical – um; montante da carina - 22; jusante da carina -19; cárdia tipo I –10. Histologia: 19 adenocarcinomas, 32 carcinomas pavimento-celulares, um linfoma. Vinte doentes (40%) - terapêutica neoadjuvante. Abordagem tóraco-abdominal – três, tóraco-abdómino-cervical – 20, transhiatal – 27, toracotomia exploradora – dois. Transposição gástrica 49 (anastomose cervical – 46; torácica - três); esofagocoloplastia cervical - um.Resultados: Estadiamento patológico: regressão completa - 8; Ib – 3; IIa – 9; IIb - 4; IIa – 11; IIIb -2; IIIc – 10; IV – 1; linfoma - um; não classificáveis – três. Complicações major: 37%. Ressecabilidade: 96% (50/52). Mortalidade: quatro semanas - 6%; hospitalar - 14%. Sobrevida mediana 18 meses [3-80]. Curvas de sobrevida (Kaplan-Meier): dois anos - 47%; cinco anos - 19%.Discussão: Não tendo sido demonstrada vantagem oncológica para a ressecção transtorácica ou a ressecção transmediastínica,basear a opção operatória na localização do tumor permitiu-nos com segurança e eficácia, planear e executar as ressecções esofágicas desta série.Conclusão: As curvas de sobrevida foram sobreponíveis para ressecção transtorácica e ressecção transmediastínica e bastantefavoráveis numa população com 52 % de estádios pIII/IV. A quimio-radioterapia contribuiu para aumentar a ressecabilidade.Palavras-chave: Esofagectomia; Laparoscopia; Neoplasias Esofágicas/cirurgia; Toracotomia.Ordem dos Médicos2014-10-25info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159oai:ojs.www.actamedicaportuguesa.com:article/5159Acta Médica Portuguesa; Vol. 27 No. 5 (2014): September-October; 593-600Acta Médica Portuguesa; Vol. 27 N.º 5 (2014): Setembro-Outubro; 593-6001646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159/4069https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159/4184Costa, PauloEsteves, RuiLages, PatríciaFerreira, Filipainfo:eu-repo/semantics/openAccess2022-12-20T11:04:14Zoai:ojs.www.actamedicaportuguesa.com:article/5159Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:02.353337Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Esophageal Cancer: Surgical Strategies Cancro do Esófago: Estratégia de Abordagem Cirúrgica |
title |
Esophageal Cancer: Surgical Strategies |
spellingShingle |
Esophageal Cancer: Surgical Strategies Costa, Paulo |
title_short |
Esophageal Cancer: Surgical Strategies |
title_full |
Esophageal Cancer: Surgical Strategies |
title_fullStr |
Esophageal Cancer: Surgical Strategies |
title_full_unstemmed |
Esophageal Cancer: Surgical Strategies |
title_sort |
Esophageal Cancer: Surgical Strategies |
author |
Costa, Paulo |
author_facet |
Costa, Paulo Esteves, Rui Lages, Patrícia Ferreira, Filipa |
author_role |
author |
author2 |
Esteves, Rui Lages, Patrícia Ferreira, Filipa |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Costa, Paulo Esteves, Rui Lages, Patrícia Ferreira, Filipa |
description |
Introduction: Oesophagectomy for cancer is associated to a significant morbidity and mortality. The superiority of transthoracic vs transhiatal is still a matter of controversy. The aim of this paper is to discuss the results of a series of patients submitted to either a transthoracic or a transhiatal according to the anatomic location regarding the carina.Material and Methods: Retrospective analysis of 52 consecutive patients, with oesophageal carcinoma, 7 female and 45 males, median age 64 [46-85] years. Location: cervical – 1; above carina - 22; below or at carina level - 19; cardia type I –10. 19 adenocarcinoma, 32 squamous cells, 1 lymphoma. Twenty patients (40%) – neo-adjuvant therapy. Thoracoabdominal approach – 3, cervico-thoracoabdominal – 20, transhiatal – 27, exploratory thoracotomy – 2. Gastric pull-up 49 (cervical anastomosis – 46; thoracic - 3); cervical oesofagocoloplasty -1.Results: Pathologic staging: complete remission - 8; Ib – 3; IIa – 9; IIb - 4; IIa – 11; IIIb -2; IIIc – 10; IV – 1; non-stageable - 3. Major complications: 37%. Resectability: 96% (50/52). Mortality: 4th week - 6%; in-hospital - 14%. Median survival 18 months [3-80]. Survival Curves (Kaplan-Meier): 2 years - 47%; 5 years - 19% (transthoracic vs transhiatal p > 0.05).Discussion: Selection of surgical approach based on the anatomic location of the tumour regarding the carina was safe, the resectability was high and similar when a transthoracic or a transhiatal was planed and carry-on.Conclusions: In this series of oesophageal cancer patients, in advanced pathologic condition (52% p Stages III/IV) the overall survival was similar for transthoracic and transhiatal. Neo-adjuvant treatments definitively contributed to enhance resectability.Keywords: Esophagectomy; Laparoscopy; Esophageal Neoplasms/surgery; Thoracotomy. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-10-25 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159 oai:ojs.www.actamedicaportuguesa.com:article/5159 |
url |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159 |
identifier_str_mv |
oai:ojs.www.actamedicaportuguesa.com:article/5159 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159/4069 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5159/4184 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
publisher.none.fl_str_mv |
Ordem dos Médicos |
dc.source.none.fl_str_mv |
Acta Médica Portuguesa; Vol. 27 No. 5 (2014): September-October; 593-600 Acta Médica Portuguesa; Vol. 27 N.º 5 (2014): Setembro-Outubro; 593-600 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799130641460101120 |