Skeletonizing en bloc esophagectomy for cancer

• Published in: Annals of surgery 2001-07, Vol.234 (1), p.25-32
• Main Authors: COLLARD, Jean-Marie, OTTE, Jean-Bernard, FIASSE, René, LATERRE, Pierre-Francois, DE KOCK, Marc, LONGUEVILLE, Jacques, GLINEUR, David, ROMAGNOLI, Renato, REYNAERT, Marc, KESTENS, Paul-Jacques
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - surgery; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagus; Female; Humans; Male; Medical sciences; Middle Aged; Neoplasm Staging; Original; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200107000-00005

To evaluate the long-term outcome of patients with esophageal cancer after resection of the extraesophageal component of the neoplastic process en bloc with the esophageal tube. Opinions are conflicting about the addition of extended resection of locoregional lymph nodes and soft tissue to removal of the esophageal tube. Esophagectomy performed en bloc with locoregional lymph nodes and resulting in a real skeletonization of the nonresectable anatomical structures adjacent to the esophagus was attempted in 324 patients. The esophagus was removed using a right thoracic (n = 208), transdiaphragmatic (n = 39), or left thoracic (n = 77) approach. Lymphadenectomy was performed in the upper abdomen and lower mediastinum in all patients. It was extended over the upper mediastinum when a right thoracic approach was used and up to the neck in 17 patients. Esophagectomy was carried out flush with the esophageal wall as soon as it became obvious that a macroscopically complete resection was not feasible. Neoplastic processes were classified according to completeness of the resection, depth of wall penetration, and lymph node involvement. Skeletonizing en bloc esophagectomy was feasible in 235 of the 324 patients (73%). The 5-year survival rate, including in-hospital deaths (5%), was 35% (324 patients); it was 64% in the 117 patients with an intramural neoplastic process versus 19% in the 207 patients having neoplastic tissue outside the esophageal wall or surgical margins (P