Thomas Haist1, Markus Mann1, Christina Oetzmann von Sochaczewski2, Michael Pauthner1, Annette Fisseler-Eckhoff3, Dietmar Lorenz4. 1. Department of Surgery, Sana Klinikum Offenbach, Teaching Hospital of the University Medicine of Frankfurt, Starkenburgring 66, 63069, Offenbach am Main, Germany. 2. Department of Surgery, Dr. Horst-Schmidt-Klinik, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany. 3. Department of Pathology, Dr. Horst-Schmidt-Klinik, Teaching Hospital of the University Medicine of Mainz, Wiesbaden, Germany. 4. Department of Surgery, Sana Klinikum Offenbach, Teaching Hospital of the University Medicine of Frankfurt, Starkenburgring 66, 63069, Offenbach am Main, Germany. Dietmar.Lorenz@sana.de.
Abstract
AIM OF THE STUDY: A matched-pair comparison between the modified Merendino resection (MER) and Ivor Lewis resection (ILR) for early Barrett's carcinoma. BACKGROUND: Early adenocarcinoma of the esophagus (eACE) with positive risk factors for lymph node metastasis (LNM) needs surgery for cure. MER appeared to be an alternative to ILR. METHODS: Between July 2000 and July 2012, 156 patients with high-grade dysplasia or eACE received ILR, whereas in 30 cases MER was performed in a tertiary care center for GI Surgery. A matched-pair analysis was performed on the basis of sex, age, BMI, ASA classification and tumor stage. Thirty patients were assigned to each group. The data were analyzed regarding perioperative aspects (e.g., operating time, hospital stay, complications, number of lymph nodes) and survival analysis. RESULTS: The mean operating time was 301.7 min for ILR, compared to 255.4 min for MER (p = 0.044). The hospital stay following ILR was significantly longer than for MER (22.4 days ILR vs. 16.4 days MER, p = 0.023). There was no statistically significant difference regarding complications between the two groups (p = 0.463). The number of resected lymph nodes was significantly lower in the MER group (median 21) compared to the ILR group, where a median of 31 lymph nodes could be removed (p < 0.001). There was no statistically significant difference in overall (p = 0.145) or tumor-specific survival (p = 0.353). CONCLUSIONS: Lymph node retrieval is significantly inferior in the MER. Postoperative complication rates were comparable between the two operating techniques, although the operation time for ILR took longer and these patients required a longer hospital stay. MER should not be applied in cases with high risk of LNM.
AIM OF THE STUDY: A matched-pair comparison between the modified Merendino resection (MER) and Ivor Lewis resection (ILR) for early Barrett's carcinoma. BACKGROUND: Early adenocarcinoma of the esophagus (eACE) with positive risk factors for lymph node metastasis (LNM) needs surgery for cure. MER appeared to be an alternative to ILR. METHODS: Between July 2000 and July 2012, 156 patients with high-grade dysplasia or eACE received ILR, whereas in 30 cases MER was performed in a tertiary care center for GI Surgery. A matched-pair analysis was performed on the basis of sex, age, BMI, ASA classification and tumor stage. Thirty patients were assigned to each group. The data were analyzed regarding perioperative aspects (e.g., operating time, hospital stay, complications, number of lymph nodes) and survival analysis. RESULTS: The mean operating time was 301.7 min for ILR, compared to 255.4 min for MER (p = 0.044). The hospital stay following ILR was significantly longer than for MER (22.4 days ILR vs. 16.4 days MER, p = 0.023). There was no statistically significant difference regarding complications between the two groups (p = 0.463). The number of resected lymph nodes was significantly lower in the MER group (median 21) compared to the ILR group, where a median of 31 lymph nodes could be removed (p < 0.001). There was no statistically significant difference in overall (p = 0.145) or tumor-specific survival (p = 0.353). CONCLUSIONS: Lymph node retrieval is significantly inferior in the MER. Postoperative complication rates were comparable between the two operating techniques, although the operation time for ILR took longer and these patients required a longer hospital stay. MER should not be applied in cases with high risk of LNM.
Authors: Roos E Pouw; Noor Heldoorn; Lorenza Alvarez Herrero; Fiebo J W ten Kate; Mike Visser; Olivier R Busch; Mark I van Berge Henegouwen; Kausilia K Krishnadath; Bas L Weusten; Paul Fockens; Jacques J Bergman Journal: Gastrointest Endosc Date: 2011-01-26 Impact factor: 9.427
Authors: Klaus L Prenzel; Elfriede Bollschweiler; Wolfgang Schröder; Stefan P Mönig; Uta Drebber; Daniel Vallboehmer; Arnulf H Hölscher Journal: Ann Thorac Surg Date: 2010-11 Impact factor: 4.330
Authors: Ahmedin Jemal; Taylor Murray; Elizabeth Ward; Alicia Samuels; Ram C Tiwari; Asma Ghafoor; Eric J Feuer; Michael J Thun Journal: CA Cancer J Clin Date: 2005 Jan-Feb Impact factor: 508.702
Authors: B Zane Atkins; Ashish S Shah; Kelley A Hutcheson; Jennifer H Mangum; Theodore N Pappas; David H Harpole; Thomas A D'Amico Journal: Ann Thorac Surg Date: 2004-10 Impact factor: 4.330
Authors: Neil H Bhayani; Aditya Gupta; Christy M Dunst; Ashwin A Kurian; Kevin M Reavis; Lee L Swanström Journal: JAMA Surg Date: 2013-08 Impact factor: 14.766