TY - JOUR
T1 - Leaving a mobilized thoracic esophagus in situ when incurable cancer is discovered intraoperatively
AU - Weijs, Teus J.
AU - Toxopeus, Eelke L A
AU - Ruurda, Jelle P.
AU - Luyer, Misha D P
AU - Nieuwenhuijzen, Grard A P
AU - Schraepen, Marie Céline
AU - Sosef, Meindert N.
AU - Wijnhoven, Bas P L
AU - Schets, Ilona R M
AU - Bleys, Ronald L A W
AU - Van Hillegersberg, Richard
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background Occasionally incurable cancer is encountered after completion of the thoracic (first) phase of a three-phase esophagectomy. The outcome of aborting the operation at this stage, leaving the mobilized thoracic esophagus in situ, is unknown. Methods A multicenter retrospective analysis was performed of patients in whom a completely mobilized thoracic esophagus was left in situ when incurable disease was discovered intraoperatively. The occurrence of esophageal necrosis or perforation, mortality, and all other adverse events were recorded and graded by severity. Results Some 18 patients were included. The median admission time was 9 days. All patients had resumed oral intake at discharge, except for 1 patient who was fed through a nasojejunal tube. After the operation, the median overall survival was 2.9 months. Postoperatively, 7 patients (39%) experienced major surgical adverse events, and 11 patients (61%) had no or only minor adverse events. Major adverse events were associated with the patient's death in 6 patients (33%), within 5 to 34 days postoperatively. Esophageal perforation or ischemia developed in 4 patients (22%) and 1 patient (6%), respectively. No predictive factors could be identified. Conclusions Leaving a completely mobilized thoracic esophagus in situ when incurable cancer was discovered intraoperatively was a successful strategy in more than half of the patients. However, one third experienced major adverse events leading to mortality.
AB - Background Occasionally incurable cancer is encountered after completion of the thoracic (first) phase of a three-phase esophagectomy. The outcome of aborting the operation at this stage, leaving the mobilized thoracic esophagus in situ, is unknown. Methods A multicenter retrospective analysis was performed of patients in whom a completely mobilized thoracic esophagus was left in situ when incurable disease was discovered intraoperatively. The occurrence of esophageal necrosis or perforation, mortality, and all other adverse events were recorded and graded by severity. Results Some 18 patients were included. The median admission time was 9 days. All patients had resumed oral intake at discharge, except for 1 patient who was fed through a nasojejunal tube. After the operation, the median overall survival was 2.9 months. Postoperatively, 7 patients (39%) experienced major surgical adverse events, and 11 patients (61%) had no or only minor adverse events. Major adverse events were associated with the patient's death in 6 patients (33%), within 5 to 34 days postoperatively. Esophageal perforation or ischemia developed in 4 patients (22%) and 1 patient (6%), respectively. No predictive factors could be identified. Conclusions Leaving a completely mobilized thoracic esophagus in situ when incurable cancer was discovered intraoperatively was a successful strategy in more than half of the patients. However, one third experienced major adverse events leading to mortality.
UR - http://www.scopus.com/inward/record.url?scp=84921839082&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2014.08.041
DO - 10.1016/j.athoracsur.2014.08.041
M3 - Article
C2 - 25499476
AN - SCOPUS:84921839082
SN - 0003-4975
VL - 99
SP - 490
EP - 494
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -