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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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| Published in: | Annals of surgical oncology 2009-04, Vol.16 (4), p.1017-1025 |
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| container_title | Annals of surgical oncology |
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| creator | Ott, Katja Bader, Franz G. Lordick, Florian Feith, Marcus Bartels, Holger Siewert, J. Ruediger |
| description | 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
|
| doi_str_mv | 10.1245/s10434-009-0336-5 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67001705</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1657273461</sourcerecordid><originalsourceid>FETCH-LOGICAL-c369t-3d35e1705c53801b8d16de2a0f21499eb58edd5d45175adc9d051ce7f45d5e7b3</originalsourceid><addsrcrecordid>eNp1kd1q3DAQhU1paP76AL0pQy9y51ayLP_0ziybdMtCAkmvhVYa7yrY0laSk-ZF-zyVuwuBQkEgMfOdM4NOln2g5DMtSv4lUFKyMiekzQljVc7fZGeUp0pZNfRtepOqydui4qfZeQiPhNCaEf4uO6UtbdKpzrLf95PfGiUHuJYqOh9gZfthQqsQ4g7hdorKjQhdH9HD6sn5fI3PJsAyuP1ObjGJxhd4NnGXlNHLuHNeKqOgszKkngsJ7p2HTqN1SnplrBsluP6v_9HGbRPsk-r7ZFU0zn6FDhbOBlRTNE8I9-gNhllVlATuZDRoYwAZQVpY_trP7bSzhkWqo7_MTno5BHx_vC-yH9fLh8W3fH17s1p061yxqo0504wjrQlXnDWEbhpNK42FJH1By7bFDW9Qa65LTmsutWo14VRh3Zdcc6w37CK7Ovjuvfs5YYhiNEHhMEiLbgqiqudPJzyBn_4BH93kbdpNFEXNStJQkiB6gJR3IXjsxd6bUfoXQYmYExeHxEVKXMyJi9n449F42oyoXxXHiBNQHICQWnaL_nXy_13_ABHzulc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>227340810</pqid></control><display><type>article</type><title>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</title><source>Springer Link</source><creator>Ott, Katja ; Bader, Franz G. ; Lordick, Florian ; Feith, Marcus ; Bartels, Holger ; Siewert, J. Ruediger</creator><creatorcontrib>Ott, Katja ; Bader, Franz G. ; Lordick, Florian ; Feith, Marcus ; Bartels, Holger ; Siewert, J. Ruediger</creatorcontrib><description>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
< .001, RR 0.16, 95% CI 0.08–0.35) as independent prognostic factors for all patients. Complications was the only independent prognostic factor (
P
< .001, RR 0.09, 95% CI 0.08–0.35) for the R0 resected patients.
Conclusions
At an experienced center, Ivor-Lewis resection is a safe surgical procedure. Outcome of patients was significantly influenced by surgical factors such as complete resection and complications. Neoadjuvant chemotherapy did not lead to higher morbidity and mortality. The high mortality from non-surgery–related complications emphasizes the importance of careful preoperative evaluation of comorbidities and patient selection.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-009-0336-5</identifier><identifier>PMID: 19189186</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>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</subject><ispartof>Annals of surgical oncology, 2009-04, Vol.16 (4), p.1017-1025</ispartof><rights>Society of Surgical Oncology 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c369t-3d35e1705c53801b8d16de2a0f21499eb58edd5d45175adc9d051ce7f45d5e7b3</citedby><cites>FETCH-LOGICAL-c369t-3d35e1705c53801b8d16de2a0f21499eb58edd5d45175adc9d051ce7f45d5e7b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19189186$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ott, Katja</creatorcontrib><creatorcontrib>Bader, Franz G.</creatorcontrib><creatorcontrib>Lordick, Florian</creatorcontrib><creatorcontrib>Feith, Marcus</creatorcontrib><creatorcontrib>Bartels, Holger</creatorcontrib><creatorcontrib>Siewert, J. Ruediger</creatorcontrib><title>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</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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
< .001, RR 0.16, 95% CI 0.08–0.35) as independent prognostic factors for all patients. Complications was the only independent prognostic factor (
P
< .001, RR 0.09, 95% CI 0.08–0.35) for the R0 resected patients.
Conclusions
At an experienced center, Ivor-Lewis resection is a safe surgical procedure. Outcome of patients was significantly influenced by surgical factors such as complete resection and complications. Neoadjuvant chemotherapy did not lead to higher morbidity and mortality. The high mortality from non-surgery–related complications emphasizes the importance of careful preoperative evaluation of comorbidities and patient selection.</description><subject>Adenocarcinoma - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - adverse effects</subject><subject>Esophagectomy - methods</subject><subject>Esophagectomy - mortality</subject><subject>Esophagogastric Junction - surgery</subject><subject>Esophagus - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Original Article-Thoracic Oncology</subject><subject>Stomach - surgery</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Thoracic Cavity</subject><subject>Treatment Outcome</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNp1kd1q3DAQhU1paP76AL0pQy9y51ayLP_0ziybdMtCAkmvhVYa7yrY0laSk-ZF-zyVuwuBQkEgMfOdM4NOln2g5DMtSv4lUFKyMiekzQljVc7fZGeUp0pZNfRtepOqydui4qfZeQiPhNCaEf4uO6UtbdKpzrLf95PfGiUHuJYqOh9gZfthQqsQ4g7hdorKjQhdH9HD6sn5fI3PJsAyuP1ObjGJxhd4NnGXlNHLuHNeKqOgszKkngsJ7p2HTqN1SnplrBsluP6v_9HGbRPsk-r7ZFU0zn6FDhbOBlRTNE8I9-gNhllVlATuZDRoYwAZQVpY_trP7bSzhkWqo7_MTno5BHx_vC-yH9fLh8W3fH17s1p061yxqo0504wjrQlXnDWEbhpNK42FJH1By7bFDW9Qa65LTmsutWo14VRh3Zdcc6w37CK7Ovjuvfs5YYhiNEHhMEiLbgqiqudPJzyBn_4BH93kbdpNFEXNStJQkiB6gJR3IXjsxd6bUfoXQYmYExeHxEVKXMyJi9n449F42oyoXxXHiBNQHICQWnaL_nXy_13_ABHzulc</recordid><startdate>20090401</startdate><enddate>20090401</enddate><creator>Ott, Katja</creator><creator>Bader, Franz G.</creator><creator>Lordick, Florian</creator><creator>Feith, Marcus</creator><creator>Bartels, Holger</creator><creator>Siewert, J. Ruediger</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20090401</creationdate><title>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</title><author>Ott, Katja ; Bader, Franz G. ; Lordick, Florian ; Feith, Marcus ; Bartels, Holger ; Siewert, J. Ruediger</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c369t-3d35e1705c53801b8d16de2a0f21499eb58edd5d45175adc9d051ce7f45d5e7b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adenocarcinoma - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - adverse effects</topic><topic>Esophagectomy - methods</topic><topic>Esophagectomy - mortality</topic><topic>Esophagogastric Junction - surgery</topic><topic>Esophagus - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Original Article-Thoracic Oncology</topic><topic>Stomach - surgery</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Thoracic Cavity</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ott, Katja</creatorcontrib><creatorcontrib>Bader, Franz G.</creatorcontrib><creatorcontrib>Lordick, Florian</creatorcontrib><creatorcontrib>Feith, Marcus</creatorcontrib><creatorcontrib>Bartels, Holger</creatorcontrib><creatorcontrib>Siewert, J. Ruediger</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ott, Katja</au><au>Bader, Franz G.</au><au>Lordick, Florian</au><au>Feith, Marcus</au><au>Bartels, Holger</au><au>Siewert, J. Ruediger</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2009-04-01</date><risdate>2009</risdate><volume>16</volume><issue>4</issue><spage>1017</spage><epage>1025</epage><pages>1017-1025</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>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
< .001, RR 0.16, 95% CI 0.08–0.35) as independent prognostic factors for all patients. Complications was the only independent prognostic factor (
P
< .001, RR 0.09, 95% CI 0.08–0.35) for the R0 resected patients.
Conclusions
At an experienced center, Ivor-Lewis resection is a safe surgical procedure. Outcome of patients was significantly influenced by surgical factors such as complete resection and complications. Neoadjuvant chemotherapy did not lead to higher morbidity and mortality. The high mortality from non-surgery–related complications emphasizes the importance of careful preoperative evaluation of comorbidities and patient selection.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>19189186</pmid><doi>10.1245/s10434-009-0336-5</doi><tpages>9</tpages></addata></record> |
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| language | eng |
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| 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 |
| title | 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 |
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