Problems Related to Radical Esophagectomy and Reconstruction -Study of Postoperative Patients without Tumor Recurrence-

Harushi Udagawa, Masahiko Tsurumaru, Yoshiaki Kajiyama, Yoshihiro Kinoshita, Kenji Tsutsumi, Takeshi Hayakawa, Masamichi Matsuda, Masashi Hashimoto, Toshihito Sawada, Goro Watanabe, Hiroshi Akiyama

Department of Surgery, Toranomon Hospital

The problems related to radical esophagectomy and reconstruction for esophageal carcinoma were investigated in 3 different patient groups without tumor recurrence. [Study A] The causes of death were investigated in 129 patients who died without tumor recurrence after radical esophagectomy. The most common causes of death after esophagectomy were pneumonia and general debility. Alcohol-related deaths and death due to ulceration of the transposed stomach were also unique to the postoperative patients. None of the causes of death was related to the specific pattern of esophageal reconstruction. Death due to heart failure occurred significantly more frequently in patients who underwent preoperative or postoperative radiation therapy. [Study B] The average survival time of 256 patients who had gone 5 years postoperatively without tumor recurrence was 8.35 +/-0.50 years, which was shorter than the average life expectancy (16.75 years) of a general population with the same sex and age distribution. [Stuay C] A questionnaire about postoperative quality of life was given to 142 patients sirviving more than 5 years without recurrence and the answers revealed postoperative problems such as frequent bile regurtitation. Regurgitation was more frequent after reconstruction via the posterior mediastinal route than via a retrosternal tunnel. However, the retrosternal and posterior mediastinal routes showed no other clear differences. Cervical dissection did not increase postoperative swallowing problems. Thus, patients who underwent radical esophagectomy and reconstruction have characteristic postoperative problems. Postoperative life expectancy was markedly shortened even in completely cured patients. No definite advantage of any particular method of reconstruction was noted.

Key words
esophageal reconstruction, postoperative QOL, tumor-nonrelated death

Reprint requests
Harushi Udagawa Deparment of Surgery, Toranomon Hospital
2-2-2 Toranomon, Minato-ku, Tokyo, 105 JAPAN

Accepted
June 14, 1995

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