Surgical Factors Influence the Outcome After Ivor-Lewis Esophagectomy with Intrathoracic Anastomosis for Adenocarcinoma of the Esophagogastric Junction: A Consecutive Series of 240 Patients at an Experienced Center

Background Despite a considerable number of randomized studies, the surgical approach to locally advanced adenocarcinoma of the esophagogastric junction (AEG) I and II is still discussed controversially. Thus, we evaluated the surgical risk and outcome after an abdominothoracic esophagectomy (Ivor-L...

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Bibliographic Details
Published in:Annals of surgical oncology 2009-04, Vol.16 (4), p.1017-1025
Main Authors: Ott, Katja, Bader, Franz G., Lordick, Florian, Feith, Marcus, Bartels, Holger, Siewert, J. Ruediger
Format: Article
Language:English
Subjects:
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
Esophageal Neoplasms - surgery
Esophagectomy - adverse effects
Esophagectomy - methods
Esophagectomy - mortality
Esophagogastric Junction - surgery
Esophagus - surgery
Female
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Article-Thoracic Oncology
Stomach - surgery
Surgery
Surgical Oncology
Thoracic Cavity
Treatment Outcome
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Summary:Background Despite a considerable number of randomized studies, the surgical approach to locally advanced adenocarcinoma of the esophagogastric junction (AEG) I and II is still discussed controversially. Thus, we evaluated the surgical risk and outcome after an abdominothoracic esophagectomy (Ivor-Lewis) with intrathoracic anastomosis as standard procedure. Methods Between 1998 and 2006, a total of 240 consecutive patients underwent standardized right thoracoabdominal esophagectomy with two-field lymphadenectomy and intrathoracic anastomosis (Ivor-Lewis operation) for AEG I ( n  = 206) or AEG II ( n  = 34). A total of 157 patients (65.4%) had neoadjuvant chemotherapy. Results Postoperative morbidity occurred in 17.9% (43 of 240). Overall mortality was 3.8% (9 of 240). The majority of patients (4 of 9) died because of severe pulmonary complications (44.4%) irrespective of surgical complications. Neoadjuvant chemotherapy did not increase morbidity or mortality. The median overall survival was 51 months. Multivariate analysis including age >75 years, clinical response to chemotherapy, complications, R-category and N-category revealed R-category ( P  = .005; relative risk [RR] 0.32, 95% confidence interval [95% CI] 0.14–0.70) and complications ( P  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-009-0336-5