Zhuangzhuang Cong1, Qiang Diao2, Jun Yi1, Lei Xiong1, Haiwei Wu1, Tao Qin1, Hua Jing1, Demin Li1, Yi Shen3. 1. Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. 2. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. 3. Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: czz061231007@126.com.
Abstract
BACKGROUND: Surgical treatment for patients with esophageal carcinoma that invades the aorta locally (stage IIIc) remains a considerable challenge. This study aimed to introduce radical esophagectomy combined with off-pump descending aorta replacement in these patients and to assess the effects on both short-term and long-term outcomes. METHODS: The clinical data of 47 patients who had esophageal carcinoma invading the descending aorta and who underwent radical esophagectomy combined with off-pump aortic replacement between January 2001 and March 2012 in Jinling Hospital were retrospectively reviewed. The intraoperative, early postoperative, and follow-up results were analyzed. RESULTS: Overall, 80.9% and 19.1% of the patients had histopathologically confirmed aortic tunica adventitia invasion and media invasion, respectively. All patients received complete resection (R0) with an average intraoperative blood loss of 227.6±63.3 mL. The mean operative time and aortic cross-clamping time were 4.9±1.3 hours and 17.0±3.2 minutes, respectively. Complications were observed in 59.6% of patients, with no hospital mortality, and all patients resumed an oral diet 1 month after the procedure. The overall 1-, 3-, and 5-year survival rates were 80.9%, 44.7%, and 21.3%, respectively, with a median survival time of 33.6 months. CONCLUSIONS: In patients with esophageal carcinoma invading the aorta, it is feasible and safe to perform radical esophagectomy combined with off-pump descending aorta replacement to improve nutritional status and achieve satisfactory survival.
BACKGROUND: Surgical treatment for patients with esophageal carcinoma that invades the aorta locally (stage IIIc) remains a considerable challenge. This study aimed to introduce radical esophagectomy combined with off-pump descending aorta replacement in these patients and to assess the effects on both short-term and long-term outcomes. METHODS: The clinical data of 47 patients who had esophageal carcinoma invading the descending aorta and who underwent radical esophagectomy combined with off-pump aortic replacement between January 2001 and March 2012 in Jinling Hospital were retrospectively reviewed. The intraoperative, early postoperative, and follow-up results were analyzed. RESULTS: Overall, 80.9% and 19.1% of the patients had histopathologically confirmed aortic tunica adventitia invasion and media invasion, respectively. All patients received complete resection (R0) with an average intraoperative blood loss of 227.6±63.3 mL. The mean operative time and aortic cross-clamping time were 4.9±1.3 hours and 17.0±3.2 minutes, respectively. Complications were observed in 59.6% of patients, with no hospital mortality, and all patients resumed an oral diet 1 month after the procedure. The overall 1-, 3-, and 5-year survival rates were 80.9%, 44.7%, and 21.3%, respectively, with a median survival time of 33.6 months. CONCLUSIONS: In patients with esophageal carcinoma invading the aorta, it is feasible and safe to perform radical esophagectomy combined with off-pump descending aorta replacement to improve nutritional status and achieve satisfactory survival.