Aamir Bilal, Muhammad Salim, Viqar Aslam, Tahira Nishtar, Adil Hussain, Gohar Ali, Arshad Khan, Intikhab Alam, Javed Iqbal Farooqi, Abdul Hameed, Ejaz Khan, Khalid Hameed, Jawad Gilani, Abbas Ilyas.
Six months follow up study of two hundred cases of Transthoracic Esophagectomy.
J Postgrad Med Inst Jan ;19(4):365-71.

Objective: To evaluate the outcome of oesophagectomy with feeding jejunostomy and no gastric drainage procedure, during 6 months of follow up. Material and Methods: This observational descriptive study was conducted at department of cardiothoracic surgery, Lady Reading Hospital Peshawar. Computerized clinical data of 200 surgically treated patients with post-op adjuvant therapy from July 2005 to June 2002 was retrospectively analyzed. Detailed scrutiny of record was carried out to determine the suitability and safety of the surgical procedure and surgical outcome. Results: A total of 200 patients (males 130, females 70) with a mean age of 42.3 years underwent oesophagectomy. Histology showed squamous cell carcinoma in 66.6% and adenocarcinoma in 33.3% patients. Postoperative morbidity was 16.5 % (33/200). The main complications of oesophagectomy were anastomotic leak in 12(6%), aspiration in 9(4.5%) and hoarseness in 8(4%) patients. The one-month postoperative mortality was 9% (18/200). Deaths were due to tracheal injury in 6(3%), pulmonary embolism in 5(2.5%), anastomotic leak in 4(2%) and respiratory failure in 3(1.5%) patients. At 6 months follow up, 46 patients (23%) were lost to follow-up and morbidity was 7.8% (12/154). Recurrence occurred in 7 (4.5%) cases; 3 patients had stricture and one each had hoarseness and incisional hernia. Conclusion: Left thoracolaparotomy and cervical anastomosis is a safe approach for carcinoma of the esophagus. Omitting a gastric drainage procedure does not adversely affect the outcome. Routine placement of a jejunostomy feeding catheter is a safe and cost effective mode of nutrition.

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