La chirurgie du cancer oesophagien à Liège. I. Etude de mortalité et de morbidité périopératoires

BACKGROUND: To assess surgical outcome after oesophagectomy, we reviewed operative techniques and postoperative course among 90 patients who underwent oesophageal resection for malignancies from January 1989 to December 1995. METHODS: There were 73 males and 17 females; mean age was 64.2 years. Indications were squamous cell carcinoma in 49 patients and adenocarcinoma in 41. Preoperatively 7 patients had chemotherapy and 18 benefited from radiochemotherapy. There were 56 total thoracic oesophagectomies, with anastomosis in the neck in 34 patients and at the thoracic inlet in 22. In 34 cases operation was limited to distal oesophageal resections. Digestive continuity was restored with the stomach in 62 patients, with the colon in 24, and with a jejunal loop in 4. A feeding jejunostomy was constructed in 48 patients with a gastric transplant. RESULTS: Mortality was 10% (9 patients), decreasing from 18.5% (before 1993) to 3.8% (since 1993). One patient died in the colonic graft group and 8 in the gastric pull-up group. Postoperative complications occurred in 9 patients after colonic interposition and in 23 after gastric pull-up; they consisted in pulmonary infection or insufficiency in 26 patients, cerebrovascular accident in one, renal insufficiency in 2, recurrent nerve palsy in 4, and anastomotic leakage in 6. Transhiatal approach was not associated with a decreased incidence of postoperative deaths or complications. Eighteen patients (72%) developed postoperative pulmonary complications after preoperative chemotherapy. CONCLUSION: Oesophagectomy can be performed with low mortality. A colonic graft is not associated with an increased incidence of perioperative deaths or complications and is the substitute of choice when there is any question regarding gastric vascularization, or in young patients with long life expectancy. Preoperative neoadjuvant treatment significantly increases postoperative pulmonary complications.