Gastro-Oesophagectomy With Two Field Lymphadenectomy- An Optimal Treatment For Resectible Carcinoma Of The Oesophagus And Gastric Cardia

Abstract

Background: The aim of the study was to examine the outcome of surgical treatment for carcinoma of the oesophagus and gastric cardia with two-field lymph node dissection at a high volume centre by a single surgeon over 7 years period.  Methods: From January 1992 to March 1999, 316 patients underwent oesophagectomy with two field lymph node clearance for cancer of the oesophagus at our unit by a single consultant surgeon. Once the data collection at the base hospital was complete, it was sent to The Cancer Intelligence Unit Information Centre at Bristol for verification of data. The data analysis was then undertaken using SPSSv9. The main technique utilized was the Kaplan-Meier survival estimate. Kaplan-Meier survival functions were produced and compared, using the log rank test, for a number of pre-specified variables and their associated levels. Multivariate analysis was performed using Cox’s proportional hazards modelling. Results: The average age at the time of surgery was 63.5 years, with a male to female ratio of 2:1. 86% of patients had dysphagia at the time of presentation. 88%(277) Patients had Ivor Lewis oesophagectomy, while 6%(20) had McKeown`s and 1%(4) had left thoracolaparotomy. 5% (14) of the patients underwent total laryngo-pharyngo-oesophagectomy. In total 62% (197) of patients had  adenocarcinoma and 31% (99) had squamous cell carcinoma. 68% (215) of patients had lymph node metastasis while 32% (101) had no lymphatic involvement at resection. 80% had pyloroplasty or pyloromyotomy. 8% had anastomotic leak. 30-day mortality was 7%. Overall 5-year survival was 33%, with a very significant survival difference between lymph node negative and positive patients (25%vs 49%; p<0.01). There was no statistically significant difference in survival on the basis of gender (p=0.47), histology (p=0.48) or age (p=0.299). In total 72 patients received adjuvant treatment and had significant survival benefit (p=0.002) but because of selection bias the results are of doubtful significance. Conclusion: It is concluded that for tumours of lower 1/2 of oesophagus Ivor Lewis oesophagectomy with two-field lymphadenectomy is safe and effective procedure. It can be performed with low morbidity and mortality and good long-term survival. . Oesophageal cancer still remains a disease of old age and that on the basis of age alone no one should be denied the opportunity of surgical resection. Gastric outlet drainage had a strong influence on the incidence of postoperative leak.