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  • 1
    Electronic Resource
    Electronic Resource
    Treatment of dysphagia in esophageal carcinoma: Transthoracic En-Bloc esophagectomy and reconstruction 48 hours later (1988)
    Springer
    Dysphagia 2 (1988), S. 222-227 
    Details
    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
    URL: http://dx.doi.org/10.1007/BF02414431
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  • 2
    Electronic Resource
    Electronic Resource
    40. Der Endobrachyoesophagus als Präcancerose (1986)
    Springer
    Langenbeck's archives of surgery 369 (1986), S. 217-223 
    Details
    ISSN: 1435-2451
    Keywords: Barrett's esophagus ; Precancerous stage ; Risk factors ; Indication ; Endobrachyoesophagus ; Precanceroue ; Risikofaktoren ; Indikation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Endobrachyoesophagus ist eine Präcancerose, da in etwa 15 der Fälle eine maligne Entartung auftritt. Nach prospektiven Studien liegt das Risiko einer Carcinomentwicklung 30- bis 42mal höher als bei der Normalbevölkerung. Risikofaktoren für die maligne Degeneration sind Alkohol- und Nicotinabusus, chronischer gastro-oesophagealer Reflux, Zugehörigkeit zur weißen Rasse und zum männlichen Geschlecht. Eine Indikation zur Antirefluxchirurgie besteht nur beim Endobrachyoesophagus mit florider Reflux-oesophagitis. Der blande Endobrachyoesophagus bedarf einer endoskopischen Kontrolle. Das Adenocarcinom des Endobrachyoesophagus ist als Speiseröhrencarcinom anzusehen und kann wegen der vorwiegend aboralen Metastasierung durch transmediastinale Oesophagektomie behandelt werden.
    Notes: Summary Barrett's esophagus is a precancerous stage as a malign degeneration occurs in about 15 %. According to prospective studies the risk of development of cancer is 30 to 42 times higher than in the normal population. Risk factors for malign degeneration, which mostly concerns white males, are abuse of alcohol or nicotine and chronic gastroesophageal reflux. Antireflux surgery is only indicated in Barrett's esophagus in combination with active reflux esophagitis. The uncomplicated Barrett's esophagus should be controlled by endoscopy. The adenocarcinoma in Barrett's esophagus has to be considered as an esophageal carcinoma. Due to its metastatic spread in mostly aboräl direction it can be treated by blunt dissection of the esophagus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01274357
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  • 3
    Electronic Resource
    Electronic Resource
    En-bloc Resektion der Speiseröhre beim Oesophaguscarcinom (1988)
    Springer
    Langenbeck's archives of surgery 373 (1988), S. 367-376 
    Details
    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
    URL: http://dx.doi.org/10.1007/BF01272555
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  • 4
    Electronic Resource
    Electronic Resource
    21. Perioperative Chemotherapie bei Plattenepithelcarcinomen des Oesophagus (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 145-148 
    Details
    ISSN: 1435-2451
    Keywords: Esophageal cancer ; Perioperative chemotherapy ; Oesophaguscarcinom ; Perioperative Chemotherapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Für die Mehrzahl der Patienten mit Oesophaguscarcinom sind lokale Tumorinfiltrationen und/oder Fernmetastasen bei der Diagnosestellung für die ungünstige Prognose verantwortlich zu machen. Zu deren Verbesserung werden zusätzliche Therapiemodalitäten - Chemotherapie allein oder in Kombination mit simultaner Strahlentherapie — perioperativ eingesetzt. Trotz einer möglichen Steigerung der Resektionsrate fehlen bisher überzeugende Ergebnisse, die angesichts der gesteigerten Toxizität einen Einsatz dieser multimodalen Therapiestrategien ausserhalb von kontrollierten Studien erlauben.
    Notes: Summary In the majority of patients with esophageal cancer local tumor infiltration and/or distant metastases are responsible for the poor prognosis. Therefore to improve life expectancy additional modalities - chemotherapy alone or in combination with simultaneous radiation - have been introduced perioperatively. In spite of a possible increase of resectability convincing data are lacking which could argue for an uncontrolled introduction of the neoadjuvant approach outside investigational studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297805
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