The Effectiveness of Transchiatal Esophagoectomy
Author`s Contribution:
- Kharkiv National Medical University, Ukraine
Background and aim of study
Today the number of patients with cancer continues to
increase. Esophageal cancer one of the most difficult
disease in terms of diagnosis and treatment, in which
surgical treatment remains the fundamental therapy.
There are many methods, which divided into 2 large
categories: transthoracic and transchiatal. Discussions
about effectiveness of the techniques are going on. It
should be noted that transchiatal access reduces
mortality from the effects of thoracotomy.
Among oncological diseases, cancer of the esophagus
takes 8th place. It is important to note the high
mortality rate from cancer of the esophagus – 350000
patients every year. The priority in modern surgery for
patients with esophageal cancer with functional
disorders of the cardiovascular and respiratory systems
is the use of transhiatal access. Extensive metaanalytical studies have been carried out in 1996
Ringani et al. and in 2002 Hulscher et al.
Research methods
For the period 2015-2018 at “V. T. Zaitsev institute of
general emergency surgery” 24 patients with
adenocarcinoma (75.0%) and squamous cell carcinoma
(25.0%) underwent resection of the esophagus with
simultaneous plastic surgery of the stomach stem. A set
of examinations was carried out: endoscopic and
radiological examinations, clinical analysis of blood
and urine, a coagulogram, a biochemical blood test, a
preoperative examination of therapist and
anesthesiologist was carried out, and the patient’s
preoperative status was determined according to the
ASA scale. The gender ratio is 15 men and 9 women.
The average age is 36 ± 5 years. The average body
mass index is 20.3. Among patients there were no
people with bad habits. All patients were divided into 2
main groups according to the method of surgical
intervention: group I – transhiatal (50.0%); II –
transthoracic (50.0%).
Results
The advantages of transchiatal access are the absence
of thoracotomy, which reduces the duration of
postoperative pain and postoperative complications.
The duration of the surgical intervention was: with
transhiatic access (I) an average of 180 ± 30.0 minutes;
group II - 360 ± 25.0 minutes. Intraoperative blood loss
was in the I group - 1000 ± 25.0 ml, II - 2000 ± 44.1
ml.
All patients of group I switched to independent
breathing and disconnected from the mechanical
ventilation on the 1st day after surgery. Among patients
in the control group, this indicator in 35.0% of patients
increased to 2 days. It is important to note that in
patients of group II, hemodynamic instability was
noted - an increase in blood pressure with poorly
amenable to correction. In group I, according to the
indicators of daily ECG monitoring, there is a lesser
degree of ischemic changes in the myocardium: an
increase in the control group by 35.3% of episodes of
ST segment depression, and the degree of ST
depression by 16.7%. In the early postoperative period,
mortality in the main group was 2 patients (the cause of
death was acute respiratory and heart failure), in the
control group – 4 (1 patient had interstitial pulmonary
edema, 2 – acute heart failure, 1 – acute respiratory
failure). The confidence is p <0.05.
The main cause of death in the early postoperative
period among patients with esophageal cancer was a
sharp disadaptation of the cardiovascular and
respiratory systems.
Conclusion
The use of transhiatric access reduces the length of stay
of patients in intensive care. It allows you to expand
the indications in patients with functional disorders of
the cardiovascular and respiratory systems,
significantly reduce the number of deaths in the
postoperative period by 8.3% compared with the
control group.
DOI and UDC
DOI: 10.26697/ijes.2019.4.48; UDC: 616.34-002.4-072
Information about the authors
Shevchenko Oleksandr Mykolajovich – Doctor of
Philosophy in Medicine, Associate Professor of
Department of Surgery No. 1, Kharkiv National
Medical University, Kharkiv, Ukraine.
Bityak Sergey Yuryevich – Doctor of Philosophy in
Medicine, Associate Professor of Department of
Surgery No. 1, Kharkiv National Medical University,
Kharkiv, Ukraine.
Polikov Heorhii Olegovych – Kharkiv National
Medical University, Kharkiv, Ukraine.