TY - JOUR
T1 - Extended esophagectomy in the management of carcinoma of the upper thoracic esophagus
AU - Vigneswaran, W. T.
AU - Trastek, V. F.
AU - Pairolero, P. C.
AU - Deschamps, C.
AU - Daly, R. C.
AU - Allen, M. S.
AU - Fell, S. C.
AU - Miller, J. I.
AU - Orringer, M. B.
N1 - Funding Information:
Production of the pleiotropic cytokine interleukin (1L)-6 is typically increased in human tissues in response to damage and may be induced by bacterial products, dur-ing viral infection, by proinflammatory cytokines such as IL-1 and tumor necrosis factor (TNF)-a, or by physical alterations [1-3]. The function of increased IL-6 production under these conditions is to induce host defense mechanisms, e.g., the acute phase response. The most relevant physical injury to human skin is ultraviolet (UV) B (290 - 315 nm) radiation. Erosion of the ozone layer and the resulting increase in UVB radiation reaching the earth's surface is thought to have deleterious effects on human health [4]. One of the most common acute adverse effects of UYE radiation is a sunburn reaction [5]. A severe sunburn reaction includes systemic effects, which are thought to be mediated at least in part by IL-6. Accordingly, increased amounts of IL-6 in sera of sunburned individuals correlated with the course of fever and in- Manuscript received December 8,1993; accepted for publication March 11,1994. This work was presented in part at the Annual Meeting of the Society for Investigative Dermatology, Washington, DC, April 28-May 1, 1993. This study was supported by grants from the Deutsche Forschungsgemeinschaft (Kr 871/3-3 and Br 1299/1-1). Reprint requests to: Dr. Jean Krutmann, Photo dermatology Section, Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg i. Br, Germany.
PY - 1994
Y1 - 1994
N2 - Upper thoracic esophageal tumors adjacent to the trachea often require a preliminary thoracotomy to accomplish resection. Between January 1985 and July 1992, 49 consecutive patients (38 men and 11 women) underwent extended esophagectomy for esophageal cancer where the neoplasm was mobilized through an initial right thoracotomy and then resected and reconstructed through an abdominocervical approach. Ages ranged from 40 to 80 years (median 63.4 years). The tumor was located in the upper third of the thoracic esophagus in 44 patients and in the middle third in five. Thirty-three patients had squamous cell carcinoma, 14 had adenocarcinoma, and two had adenosquamous cell carcinoma. Complications occurred in 35 patients (71.4%) and included anastomotic leak in 15, vocal cord paralysis in 11, atrial arrhythmia in nine, pneumonia in six, wound infection in five, and postoperative bleeding in one. Three patients required tracheostomy. There was one postoperative death (2.0%). Median survival was 0.9 years (range 1 month to 5.1 years). Thirty-one patients were alive at the time this article was written, 28 without evidence of cancer. Cause of death was recurrent disease in 13 patients, unrelated to cancer in three, and unknown in one. Overall actuarial 3- and 5-year survivals were 48.6% and 18.2%, respectively. Four-year survival for stage II disease was 44.6% as compared to 24.9% for stage III (p < 0.02). The presence of lymph node metastases significantly affected survival. Three-year survival for patients with N0 disease was 77.9% compared with 20.9% for patients with N1 disease (p < 0.01). Age, sex, and cell type had no effect on survival. Ten patients had late dysphagia, four had gastroesophageal reflux, and one had dumping symptoms. Although associated with significant morbidity, we conclude that extended esophagectomy is an acceptable method of management for tumors of the upper thoracic esophagus. Mortality is low, and long-term results are reasonable.
AB - Upper thoracic esophageal tumors adjacent to the trachea often require a preliminary thoracotomy to accomplish resection. Between January 1985 and July 1992, 49 consecutive patients (38 men and 11 women) underwent extended esophagectomy for esophageal cancer where the neoplasm was mobilized through an initial right thoracotomy and then resected and reconstructed through an abdominocervical approach. Ages ranged from 40 to 80 years (median 63.4 years). The tumor was located in the upper third of the thoracic esophagus in 44 patients and in the middle third in five. Thirty-three patients had squamous cell carcinoma, 14 had adenocarcinoma, and two had adenosquamous cell carcinoma. Complications occurred in 35 patients (71.4%) and included anastomotic leak in 15, vocal cord paralysis in 11, atrial arrhythmia in nine, pneumonia in six, wound infection in five, and postoperative bleeding in one. Three patients required tracheostomy. There was one postoperative death (2.0%). Median survival was 0.9 years (range 1 month to 5.1 years). Thirty-one patients were alive at the time this article was written, 28 without evidence of cancer. Cause of death was recurrent disease in 13 patients, unrelated to cancer in three, and unknown in one. Overall actuarial 3- and 5-year survivals were 48.6% and 18.2%, respectively. Four-year survival for stage II disease was 44.6% as compared to 24.9% for stage III (p < 0.02). The presence of lymph node metastases significantly affected survival. Three-year survival for patients with N0 disease was 77.9% compared with 20.9% for patients with N1 disease (p < 0.01). Age, sex, and cell type had no effect on survival. Ten patients had late dysphagia, four had gastroesophageal reflux, and one had dumping symptoms. Although associated with significant morbidity, we conclude that extended esophagectomy is an acceptable method of management for tumors of the upper thoracic esophagus. Mortality is low, and long-term results are reasonable.
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U2 - 10.1016/s0022-5223(94)70348-5
DO - 10.1016/s0022-5223(94)70348-5
M3 - Article
C2 - 8127121
AN - SCOPUS:0028207992
SN - 0022-5223
VL - 107
SP - 901
EP - 907
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -