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  • Mediastinal lymphadenectomy  (3)
  • Esophageal replacement  (2)
  • 1
    ISSN: 1432-0460
    Keywords: Esophageal cancer ; Transthoracic esophagectomy ; Mediastinal lymphadenectomy ; Delayed reconstruction ; Blunt esophageal dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 82 consecutive patients with esophageal cancer (90% squamous cell carcinoma, 10% adenocarcinoma) transthoracic “en bloc” esophagotomy with regional lymphadenectomy was performed. The reconstruction with gastric interposition was carried out with delayed urgency in a second operation 48–72 h after the initial procedure. The results of this group were compared to a group of 65 patients who had transmediastinal esophagectomy without thoractotomy and mediastinal as well as suprapancreatic lymphadenectomy and immediate reconstruction by gastric interposition. The number of postoperative risk situations concerning cardiopulmonary features were comparable in both groups. The 30-day mortality rate and postoperative morbidity was not significantly different between both patient groups (mortality rate: transthoracic: 6.6%, transmediastinal: 7.7%). The advantages of a 2-stage procedure are that esophagectomy and especially mediastinal lymphadenectomy can be performed precisely without time pressure. After 2 days the stomach is hypotonic and dilated as a result of truncal vagotomy and can easily be elevated to the neck. The interval of 48–72 hours was chosen because the postoperative right-to-left shunt has nearly normalized after this time period. En bloc esophagectomy and reconstruction with delayed urgency can be performed without disadvantages compared to a 1-stage procedure. It can especially be recommended for operations in which esophagectomy and mediastinal lymphadenectomy are difficult and wearisome.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 361 (1983), S. 892-892 
    ISSN: 1435-2451
    Keywords: Columnar cell-lined lower esophagus ; Subtotal esophagectomy ; Esophageal replacement ; Endobrachyoesophagus ; Subtotale Oesophagektomie ; Speiseröhrenersatz
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Endobrachyoesophagus (Auskleidung des distalen Oesophagus mit Zylinderepithel statt mit Plattenepithel) stellt eine fakultative Präcancerose dar. Entsteht im distalen Oesophagus ein Adenocarcinom, so muß es wie ein Oesophaguscarcinom behandelt werden. Der Film zeigt die chirurgische Technik der subtotalen Oesophagektomie mit einzeitigem Ersatz der Speiseröhre durch Magen. Dabei wird eine spezielle intrathorakale Anastomose vorgestellt, die ein Höchstmaß an Sicherheit bietet.
    Notes: Summary The columnar cell-lined lower esophagus represents potential precancerosis. If an adeno carcinoma develops in the distal esophagus, it has to be treated as a carcinoma of the esophagus. The film shows the surgical technique of subtotal esophagectomy with simultaneous replacement of the esophagus by means of the stomach. Here a special intrathoracic anastomosis is demonstrated, which provides a high safety rate.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 373 (1988), S. 367-376 
    ISSN: 1435-2451
    Keywords: Esophageal cancer ; En bloc esophagectomy ; Mediastinal lymphadenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die en-bloc Oesophagektomie erfaßt neben der Entfernung der Speiseröhre die mediastinale Lymphadenektomie incl. der Resektion von V. azygos und Ductus thoracicus. Zusätzlich beinhaltet sie die suprapankreatische abdominelle Lymphadenektomie und bei oberhalb der Trachealbifurkation gelegenen Tumoren auch die cervicale Lymphadenektomie. Die Operationstechnik kann als ausgereift und standardisiert angesehen werden. Mögliche Komplikationen sind Nachblutungen (3,3%), Chylothorax (1,6%) und Trachealäsionen (4,9%). Die Letalität liegt in erfahrenen Zentren unter 10%, im eigenen Krankengut bei 6,6%. Die en-bloc Oesophagektomie ermöglicht ein exaktes Staging des Oesophaguscarcinoms, führt in einem hohen Prozentsatz zur kompletten Tumorentfernung (R0-Resektion) und scheint die Prognose früher Tumorstadien (T1/2 N0/1) zu verbessern.
    Notes: Summary En-bloc esophagectomy not only comprises the elimination of the esophagus but also the mediastinal lymphadenectomy and the resection of the azygos vein and thoracic duct. Additionally the suprapancreatic abdominal lymphadenectomy is included and in tumors located orally of the tracheal bifurcation also the cervical lymphadenectomy. The surgical technique can be estimated as fully developed and standardized. Possible complications are postoperative hemorrhage (3.3%), chylothorax (1.6%) and tracheal lesions (4.9%). The mortality rate ranges under 10% in experienced centers, in our own patients around 6.6%. With en-bloc esophagectomy an exact staging of esophageal cancer becomes possible. In a high percentage complete tumor elimination (R0-resection) can be achieved and it seems that herewith prognosis in early tumor stages (T1/2 N0/1) can be improved.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 233-239 
    ISSN: 1435-2451
    Keywords: Esophageal replacement ; Gastric interposition ; Speiseröhrenersatz ; Mageninterposition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Das Verfahren der ersten Wahl für den Speiseröhrenersatz ist die Mageninterposition. Als Alternative steht bei Voroperationen am Magen der Ersatz durch Colon zur Verfügung. In eigenen Nachuntersuchungen fanden wir bei Patienten mit Mageninterposition eine beschleunigte Entleerung, nach Coloninterposition dagegen insgesamt eine verzögerte Entleerung. Trotz persistierender Säuresekretion des interponierten Magens spielte der gastro-oesophageale Reflux bei kompletter Intrathorakalverlagerung des Magens keine nennenswerte Rolle.
    Notes: Summary The procedure of first choice for esophageal replacement is gastric interposition. Alternatively the replacement by colon is possible after gastric surgery. In our own examinations patients with gastric interposition had an accelerated emptying while those with colon interposition showed a delayed emptying. In spite of persisting acid secretion of the interpositioned stomach the gastroesophageal reflux was of minor importance after total intrathoracic position of the stomach.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 924-924 
    ISSN: 1435-2451
    Keywords: Esophageal carcinoma ; En-bloc esophagectomy ; Mediastinal lymphadenectomy ; Esophagogastrostomy ; Oesophaguscarcinom ; En-bloc-Oesophagektomie ; Mediastinale Lymphadenektomie ; Oesophago-Gastrostomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Film zeigt die Technik der en-bloc-Oesophagektomie beim Oesophaguscarcinom. Bei dieser Operationstechnik werden der Oesophagus nebst angrenzendem mediastinalem Lymph- und Fettgewebe inclusive der V. azygos und des Ductus thoracicus entfernt. Diese Ausräumung des Mediastinums führt zu einer mediastinalen Lymphadenektomie. Zusätzlich werden Ausmass und Technik der abdominellen Lymphadenektomie gezeigt. Die Rekonstruktion der Speisepassage erfolgt durch Mageninterposition mit cervicaler Oesophago-Gastrostomie.
    Notes: Summary The film shows the technique of en-bloc esophagectomy in esophageal carcinoma. With this surgical technique it is possible to resect the esophagus with the surrounding lymphatic and fatty tissue, including the azygos vein and the thoracic duct. This mediastinectomy leads to a regional lymphadenectomy. In addition, the extent and technique of abdominal lymphadenectomy are also shown. Reconstruction of the food passageway is done by gastric interposition with cervical esophagogastrostomy.
    Type of Medium: Electronic Resource
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