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Mo1718 Esophagectomy for Cancer Can Be Performed Safely and With Good Perioperative Outcomes in Octagenerians
Mo1715
in diagnosis and surgical treatment on 7 patients with esophageal cancer and coexistent intrathoracic great vessel anomalies. [Methods] From January 2007 through November 2012, 1032 patients with esophageal carcinoma underwent cure intent esophagectomy. Among them there were 7 patients with coexistent intrathoracic great vessel anomalies (0.68%), including aberrant right subclavian artery (ARSA) in 3 patients, abnormal left brachiocephalic vein drainage in 2, right aortic arch (RAA) in 1 and aortic isthmus pseudoaneurysm in 1. They were 6 males and 1 female, with an average age of 58.42 years. Their examination findings and surgical treatment result were retrospectively analyzed. [Results] The vessel anomalies were all missed on preoperative routine esophageal barium study and endoscopy. They were mostly identified by enhanced chest CT, some with the help of 3D vessel reconstruction or angiogram. During operation, the aortic malformation needed additional management: patient with RAA had ductus arteriusus ligation and dissection to facilitate the mobilization of the esophagus via left thoracotomy, while the aortic pseudoaneurysm underwent endovascular stent implantation before esophagectomy via right thoracotomy. All the other anomalies did not need special treatment, while caution was needed when performed lymphadenectomy due to the varied right recurrent laryngeal nerve or abnormal vein drainage. Besides, the thoracic duct was routinely ligated. All patients were recovered and discharged unevenly. [Conclusion] The intrathoracic great vessel anomalies that coexisted with esophageal carcinoma are easily neglected on esophageal barium study or endoscopy. Therefore, enhanced chest CT should be a preoperative routine examination, with additional angiogram or 3D reconstruction. The vessel anomaly might interfere the mobilization of the esophagus and need be clarified before the operation. Some need pretreatment like ductus arteriusus ligation or endovascular stent implantation to facilitate the esophageal mobilization. A careful lymphadenectomy and prophylactic ligation of thoracic duct are recommended to avoid associated complications. If necessary, the abnormal vessel can be dissected to prevent uncontrolled bleeding.
Outcomes of Esophagectomy for Esophageal Achalasia in the United States Daniela Molena, Miloslawa Stem, Anne O. Lidor
SSAT Abstracts
Background: While the outcomes after Heller myotomy have been extensively reported, little is known about patients with esophageal achalasia who are treated with esophagectomy. Methods: This was a retrospective analysis using the Nationwide Inpatient Sample over an 11-year period (2000-2010). Patients admitted with a primary diagnosis of achalasia who underwent esophagectomy (Group 1) were compared to patients with esophageal cancer who underwent esophagectomy (Group 2) during the same time period. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), post-operative complications and total hospital charges. A propensity-matched analysis was conducted comparing these same outcomes between Group 1 and well-matched controls in Group 2 during the same era. Results: Among 43,668 patients admitted with a primary diagnosis of achalasia, 963 (2.2%) underwent esophagectomy. The overall in-hospital mortality in Group 1 was 2.7%. The most common post-operative complications in this group were pneumonia (17%) and pulmonary compromise (29%). During the same time period, 18,003 patients with esophageal cancer underwent esophagectomy. Patients in Group 1 were younger, healthier, and had a lower mortality when compared to Group 2. Post operative LOS and complications were similar in both groups, although hospital charges were significantly higher in Group 1. (Table 1). The most common surgical procedure was a partial esophagectomy in both groups. The number of colon interpositions was higher in Group 1 (1% versus 4%, p=0.0001). The propensity matched analysis showed a trend toward a higher mortality in Group 2 (7.8% versus 2.9%, p=0.08). Among patients who died in both groups the most common associated diagnosis codes were respiratory complications and sepsis. Older male patients had the highest mortality among patients with achalasia. Conclusion: This is the largest study to date examining outcomes after esophagectomy in patients with achalasia. In these patients, unadjusted mortality is statistically lower than in patients with esophageal cancer, while operative morbidity appears comparable. In a propensity matched analysis, there remains a trend toward lower mortality in Group 1. Based on these data, esophagectomy can be considered a safe option, and surgeons should not be hindered by a perceived notion of prohibitive operative risk in this patient population.
Mo1718 Esophagectomy for Cancer Can Be Performed Safely and With Good Perioperative Outcomes in Octagenerians Vadim P. Koshenkov, Tulay Koru-Sengul, Angela T. Prescott, Carlo Maria Rosati, Monika E. Freiser, Danny Yakoub, Alan S. Livingstone Introduction: The number of elderly patients that are being diagnosed with cancer in the United States has risen, as lifespan has increased. Consequently, octogenarians are now considered more frequently for operations with high rates of mortality and morbidity, such as esophagectomy. Inconsistent data exists regarding the outcomes of esophagectomy in this population group. Methods: A retrospective review was performed for patients that had undergone esophagectomy for cancer at a tertiary care referral center from 1/2000 to 6/ 2012. Clinicopathologic factors and survival data for octogenarians were analyzed and compared to patients who were 79 years old or younger. Results: Among the 34 patients who met the inclusion criteria, 21 (61.8%) had comorbidities. Of these, pre-existing cardiac disease was identified in 16 (47.1%), pulmonary in 6 (17.6%) and diabetes mellitus in 3 (8.8%). Median age was 82, 76.5% were male, 76.5% had adenocarcinoma that was distal (88.3%), and 50.0% of tumors were poorly differentiated. Stages 0 through III were observed in 2 (5.9%), 6 (17.6%), 9 (26.5%) and 17 (50.0%) patients, respectively. Neoadjuvant chemotherapy or chemoradiotherapy was administered to 25 (73.5%) patients, with 12 (48.0%) undergoing downstaging. Transhiatal esophagectomy was performed in 28 (82.4%) patients, with an r0 resection in 31 (91.2%). Median length of stay (LOS) was 10 days. Mortality and morbidity rates were 5.9% and 44.1%. These were not significantly different from 10 days, 4.4% and 46.1%, respectively, for a group of 293 patients that were 79 years old or younger. Cardiac, pulmonary, and infectious complications were encountered in 17.6%, 14.7%, and 2.9%, respectively. Anastomotic leak occurred in 5 (14.7%) patients, and reoperation rate was 2.9%. Median, 3-year, and 5-year survival were 21 months, 55.9%, and 37.1% respectively. Overall survival was worse for octogenarians when compared to younger patients (p,0.0001)(Figure 1). Conclusion: Mortality, morbidity and length of stay in octogenarians were comparable to patients who were 79 years old or younger, while the overall survival was worse. With appropriate patient selection, good perioperative outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.
Mo1716 Comparison of Long Term Survival After Endoscopic Resection vs. Ablation in Early Esophageal Cancer: An Analysis of Surveillance Epidemiology and End Results Data Attila Dubecz, Norbert Solymosi, Rudolf J. Stadlhuber, Michael Schweigert, Jeffrey H. Peters, Hubert J. Stein BACKGROUND: Safety and efficacy of endoscopic therapy for early esophageal cancer is well established but long-term outcomes are not available. Our objective was to assess and compare long-term survival in patients with early esophageal cancer managed with either endoscopic mucosal resection (EMR) or ablative treatments (AT). METHODS: We identified 495 patients with endoscopically treated early adenocarcinoma of the esophagus and the gastric cardia diagnosed between 1998 and 2009 from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic variables and cancer-related survival were assessed. RESULTS: Almost 80% of all patients were male. Average age was 66.5y. Fortypercent of the patients had T1a cancer. More than 88% of the patients were treated with EMR. Average follow-up was 33.6 months. Although five-year cancer related survival was slightly superior after AT (81% vs.78%; p ,0.001), ten-year survival rates were significantly better in patients undergoing EMR (78% vs. 61%; p ,0.001). CONCLUSION: Patients with early esophageal cancer managed with EMR have superior long-term survival compared to those treated with ablative therapies. Mo1717 Diagnosis and Surgical Treatment of Esophageal Carcinoma With Coexistent Intrathoracic Great Vessel Anomalies Long-Qi Chen, Zhongxi Niu [Objective] Intrathoracic great vessels accompany the full course of the esophagus in chest. The anomalies of these vessels can not only result in dysphagia symptom by direct compression, but also make the resection of esophageal cancer more difficult due to the malformation or even direct invasion of these vessels. The aim of this study is to summarize our experience
SSAT Abstracts
S-1098
in diagnosis and surgical treatment on 7 patients with esophageal cancer and coexistent intrathoracic great vessel anomalies. [Methods] From January 2007 through November 2012, 1032 patients with esophageal carcinoma underwent cure intent esophagectomy. Among them there were 7 patients with coexistent intrathoracic great vessel anomalies (0.68%), including aberrant right subclavian artery (ARSA) in 3 patients, abnormal left brachiocephalic vein drainage in 2, right aortic arch (RAA) in 1 and aortic isthmus pseudoaneurysm in 1. They were 6 males and 1 female, with an average age of 58.42 years. Their examination findings and surgical treatment result were retrospectively analyzed. [Results] The vessel anomalies were all missed on preoperative routine esophageal barium study and endoscopy. They were mostly identified by enhanced chest CT, some with the help of 3D vessel reconstruction or angiogram. During operation, the aortic malformation needed additional management: patient with RAA had ductus arteriusus ligation and dissection to facilitate the mobilization of the esophagus via left thoracotomy, while the aortic pseudoaneurysm underwent endovascular stent implantation before esophagectomy via right thoracotomy. All the other anomalies did not need special treatment, while caution was needed when performed lymphadenectomy due to the varied right recurrent laryngeal nerve or abnormal vein drainage. Besides, the thoracic duct was routinely ligated. All patients were recovered and discharged unevenly. [Conclusion] The intrathoracic great vessel anomalies that coexisted with esophageal carcinoma are easily neglected on esophageal barium study or endoscopy. Therefore, enhanced chest CT should be a preoperative routine examination, with additional angiogram or 3D reconstruction. The vessel anomaly might interfere the mobilization of the esophagus and need be clarified before the operation. Some need pretreatment like ductus arteriusus ligation or endovascular stent implantation to facilitate the esophageal mobilization. A careful lymphadenectomy and prophylactic ligation of thoracic duct are recommended to avoid associated complications. If necessary, the abnormal vessel can be dissected to prevent uncontrolled bleeding.
Outcomes of Esophagectomy for Esophageal Achalasia in the United States Daniela Molena, Miloslawa Stem, Anne O. Lidor
SSAT Abstracts
Background: While the outcomes after Heller myotomy have been extensively reported, little is known about patients with esophageal achalasia who are treated with esophagectomy. Methods: This was a retrospective analysis using the Nationwide Inpatient Sample over an 11-year period (2000-2010). Patients admitted with a primary diagnosis of achalasia who underwent esophagectomy (Group 1) were compared to patients with esophageal cancer who underwent esophagectomy (Group 2) during the same time period. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), post-operative complications and total hospital charges. A propensity-matched analysis was conducted comparing these same outcomes between Group 1 and well-matched controls in Group 2 during the same era. Results: Among 43,668 patients admitted with a primary diagnosis of achalasia, 963 (2.2%) underwent esophagectomy. The overall in-hospital mortality in Group 1 was 2.7%. The most common post-operative complications in this group were pneumonia (17%) and pulmonary compromise (29%). During the same time period, 18,003 patients with esophageal cancer underwent esophagectomy. Patients in Group 1 were younger, healthier, and had a lower mortality when compared to Group 2. Post operative LOS and complications were similar in both groups, although hospital charges were significantly higher in Group 1. (Table 1). The most common surgical procedure was a partial esophagectomy in both groups. The number of colon interpositions was higher in Group 1 (1% versus 4%, p=0.0001). The propensity matched analysis showed a trend toward a higher mortality in Group 2 (7.8% versus 2.9%, p=0.08). Among patients who died in both groups the most common associated diagnosis codes were respiratory complications and sepsis. Older male patients had the highest mortality among patients with achalasia. Conclusion: This is the largest study to date examining outcomes after esophagectomy in patients with achalasia. In these patients, unadjusted mortality is statistically lower than in patients with esophageal cancer, while operative morbidity appears comparable. In a propensity matched analysis, there remains a trend toward lower mortality in Group 1. Based on these data, esophagectomy can be considered a safe option, and surgeons should not be hindered by a perceived notion of prohibitive operative risk in this patient population.
Mo1718 Esophagectomy for Cancer Can Be Performed Safely and With Good Perioperative Outcomes in Octagenerians Vadim P. Koshenkov, Tulay Koru-Sengul, Angela T. Prescott, Carlo Maria Rosati, Monika E. Freiser, Danny Yakoub, Alan S. Livingstone Introduction: The number of elderly patients that are being diagnosed with cancer in the United States has risen, as lifespan has increased. Consequently, octogenarians are now considered more frequently for operations with high rates of mortality and morbidity, such as esophagectomy. Inconsistent data exists regarding the outcomes of esophagectomy in this population group. Methods: A retrospective review was performed for patients that had undergone esophagectomy for cancer at a tertiary care referral center from 1/2000 to 6/ 2012. Clinicopathologic factors and survival data for octogenarians were analyzed and compared to patients who were 79 years old or younger. Results: Among the 34 patients who met the inclusion criteria, 21 (61.8%) had comorbidities. Of these, pre-existing cardiac disease was identified in 16 (47.1%), pulmonary in 6 (17.6%) and diabetes mellitus in 3 (8.8%). Median age was 82, 76.5% were male, 76.5% had adenocarcinoma that was distal (88.3%), and 50.0% of tumors were poorly differentiated. Stages 0 through III were observed in 2 (5.9%), 6 (17.6%), 9 (26.5%) and 17 (50.0%) patients, respectively. Neoadjuvant chemotherapy or chemoradiotherapy was administered to 25 (73.5%) patients, with 12 (48.0%) undergoing downstaging. Transhiatal esophagectomy was performed in 28 (82.4%) patients, with an r0 resection in 31 (91.2%). Median length of stay (LOS) was 10 days. Mortality and morbidity rates were 5.9% and 44.1%. These were not significantly different from 10 days, 4.4% and 46.1%, respectively, for a group of 293 patients that were 79 years old or younger. Cardiac, pulmonary, and infectious complications were encountered in 17.6%, 14.7%, and 2.9%, respectively. Anastomotic leak occurred in 5 (14.7%) patients, and reoperation rate was 2.9%. Median, 3-year, and 5-year survival were 21 months, 55.9%, and 37.1% respectively. Overall survival was worse for octogenarians when compared to younger patients (p,0.0001)(Figure 1). Conclusion: Mortality, morbidity and length of stay in octogenarians were comparable to patients who were 79 years old or younger, while the overall survival was worse. With appropriate patient selection, good perioperative outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.
Mo1716 Comparison of Long Term Survival After Endoscopic Resection vs. Ablation in Early Esophageal Cancer: An Analysis of Surveillance Epidemiology and End Results Data Attila Dubecz, Norbert Solymosi, Rudolf J. Stadlhuber, Michael Schweigert, Jeffrey H. Peters, Hubert J. Stein BACKGROUND: Safety and efficacy of endoscopic therapy for early esophageal cancer is well established but long-term outcomes are not available. Our objective was to assess and compare long-term survival in patients with early esophageal cancer managed with either endoscopic mucosal resection (EMR) or ablative treatments (AT). METHODS: We identified 495 patients with endoscopically treated early adenocarcinoma of the esophagus and the gastric cardia diagnosed between 1998 and 2009 from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic variables and cancer-related survival were assessed. RESULTS: Almost 80% of all patients were male. Average age was 66.5y. Fortypercent of the patients had T1a cancer. More than 88% of the patients were treated with EMR. Average follow-up was 33.6 months. Although five-year cancer related survival was slightly superior after AT (81% vs.78%; p ,0.001), ten-year survival rates were significantly better in patients undergoing EMR (78% vs. 61%; p ,0.001). CONCLUSION: Patients with early esophageal cancer managed with EMR have superior long-term survival compared to those treated with ablative therapies. Mo1717 Diagnosis and Surgical Treatment of Esophageal Carcinoma With Coexistent Intrathoracic Great Vessel Anomalies Long-Qi Chen, Zhongxi Niu [Objective] Intrathoracic great vessels accompany the full course of the esophagus in chest. The anomalies of these vessels can not only result in dysphagia symptom by direct compression, but also make the resection of esophageal cancer more difficult due to the malformation or even direct invasion of these vessels. The aim of this study is to summarize our experience
SSAT Abstracts
S-1098