Gastric substitution for resectable carcinoma of the esophagus: An analysis of 368 cases

Liang Shun Wang, Min Hsiung Huang, Biing Shiun Huang, Kwang Yu Chien

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%). In studies of total esophageal substitute transit time and technetium 99m-HIDA test (n = 33), we found that pyloroplasty or pyloromyotomy failed to normalize the disturbed gastric emptying but resulted in a high incidence of enterogastric bile reflux. Thus, we conclude that routine pyloroplasty or pyloromyotomy is not necessary. Although more than half of our patients had experience with late complications of gastric transplantation, most of them (>80%) can take care of themselves and their daily work after proper medication and physical therapy, if there is no tumor recurrence or other associated diseases.

Original languageEnglish
Pages (from-to)289-294
Number of pages6
JournalAnnals of Thoracic Surgery
Volume53
Issue number2
DOIs
Publication statusPublished - 1992
Externally publishedYes

Fingerprint

Esophagus
Stomach
Carcinoma
Dumping Syndrome
Aspiration Pneumonia
Stomach Ulcer
Dilatation
Incidence
Pathologic Constriction
Bile Reflux
Veterans Hospitals
Gastric Emptying
Technetium
Lymph Node Excision
Bile Acids and Salts
Bile
General Hospitals
Abdomen
Dyspnea
Thoracic Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Gastric substitution for resectable carcinoma of the esophagus : An analysis of 368 cases. / Wang, Liang Shun; Huang, Min Hsiung; Huang, Biing Shiun; Chien, Kwang Yu.

In: Annals of Thoracic Surgery, Vol. 53, No. 2, 1992, p. 289-294.

Research output: Contribution to journalArticle

Wang, Liang Shun ; Huang, Min Hsiung ; Huang, Biing Shiun ; Chien, Kwang Yu. / Gastric substitution for resectable carcinoma of the esophagus : An analysis of 368 cases. In: Annals of Thoracic Surgery. 1992 ; Vol. 53, No. 2. pp. 289-294.
@article{4e68dcfb717d4803a0727d0a1f780baf,
title = "Gastric substitution for resectable carcinoma of the esophagus: An analysis of 368 cases",
abstract = "Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6{\%}. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2{\%}), posteromediastinal (7.1{\%}), and intrathoracic (15.7{\%}). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3{\%} and 6.5{\%}, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5{\%}. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4{\%} and 7.6{\%}, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1{\%}; postprandial fullness of abdomen, 38.2{\%}; dumping syndrome, 13.2{\%}; distended stomach with dyspnea, 11.8{\%}; aspiration pneumonia, 6.6{\%}; and gastric ulcer, 6.6{\%}. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5{\%} versus 8.6{\%}), dumping syndrome (33.3{\%} versus 6.9{\%}), aspiration pneumonia (16.7{\%} versus 3.4{\%}), and gastric ulcer (22.2{\%} versus 1.7{\%}). In studies of total esophageal substitute transit time and technetium 99m-HIDA test (n = 33), we found that pyloroplasty or pyloromyotomy failed to normalize the disturbed gastric emptying but resulted in a high incidence of enterogastric bile reflux. Thus, we conclude that routine pyloroplasty or pyloromyotomy is not necessary. Although more than half of our patients had experience with late complications of gastric transplantation, most of them (>80{\%}) can take care of themselves and their daily work after proper medication and physical therapy, if there is no tumor recurrence or other associated diseases.",
author = "Wang, {Liang Shun} and Huang, {Min Hsiung} and Huang, {Biing Shiun} and Chien, {Kwang Yu}",
year = "1992",
doi = "10.1016/0003-4975(92)91335-7",
language = "English",
volume = "53",
pages = "289--294",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Gastric substitution for resectable carcinoma of the esophagus

T2 - An analysis of 368 cases

AU - Wang, Liang Shun

AU - Huang, Min Hsiung

AU - Huang, Biing Shiun

AU - Chien, Kwang Yu

PY - 1992

Y1 - 1992

N2 - Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%). In studies of total esophageal substitute transit time and technetium 99m-HIDA test (n = 33), we found that pyloroplasty or pyloromyotomy failed to normalize the disturbed gastric emptying but resulted in a high incidence of enterogastric bile reflux. Thus, we conclude that routine pyloroplasty or pyloromyotomy is not necessary. Although more than half of our patients had experience with late complications of gastric transplantation, most of them (>80%) can take care of themselves and their daily work after proper medication and physical therapy, if there is no tumor recurrence or other associated diseases.

AB - Between 1974 and 1984, 1,188 patients with esophageal malignancies were treated in the Division of Thoracic Surgery of Veterans General Hospital, Taipei. The rate of resectability was 42.6%. Since 1974, the stomach has been used as esophageal substitute, and through 1984, a total of 368 patients were collected. The routes of reconstruction included retrosternal (77.2%), posteromediastinal (7.1%), and intrathoracic (15.7%). The rates of postoperative complications and surgical mortality in these 368 patients were 26.3% and 6.5%, respectively. Leakage of anastomosis was the most frequent complication. The incidence of stricture of esophagogastrostomy was 25.5%. All strictures were relieved by esophageal dilations. An average of 3.9 esophageal dilations were performed per patient (range, 1 to 15). Radical lymph node dissection was not routinely performed in our series. The actuarial 2-year and 5-year survival rates were 26.4% and 7.6%, respectively. Among 76 patients undergoing cervical esophagogastrostomy and surviving for more than 1 year, late complications occurred as follows: acid/bile regurgitation, 46.1%; postprandial fullness of abdomen, 38.2%; dumping syndrome, 13.2%; distended stomach with dyspnea, 11.8%; aspiration pneumonia, 6.6%; and gastric ulcer, 6.6%. Moreover, compared with patients without pyloroplasty, those with pyloroplasty were found to have a higher incidence of bile regurgitation (55.5% versus 8.6%), dumping syndrome (33.3% versus 6.9%), aspiration pneumonia (16.7% versus 3.4%), and gastric ulcer (22.2% versus 1.7%). In studies of total esophageal substitute transit time and technetium 99m-HIDA test (n = 33), we found that pyloroplasty or pyloromyotomy failed to normalize the disturbed gastric emptying but resulted in a high incidence of enterogastric bile reflux. Thus, we conclude that routine pyloroplasty or pyloromyotomy is not necessary. Although more than half of our patients had experience with late complications of gastric transplantation, most of them (>80%) can take care of themselves and their daily work after proper medication and physical therapy, if there is no tumor recurrence or other associated diseases.

UR - http://www.scopus.com/inward/record.url?scp=0026567732&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026567732&partnerID=8YFLogxK

U2 - 10.1016/0003-4975(92)91335-7

DO - 10.1016/0003-4975(92)91335-7

M3 - Article

C2 - 1731671

AN - SCOPUS:0026567732

VL - 53

SP - 289

EP - 294

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 2

ER -