Clinical Application of Exclusive Right-Thoracic Approach in Surgery with or without Laparotomy for Mid-Upper Esophageal Cancer

Juwei MU, Fang LU, Jian LI, Guiyu CHENG, Kelin SUN, Rugang ZHANG, Jie HE

Abstract


OBJECTIVE    To  evaluate the clinical application of a  right-thoracic  ap-proach with or without laparotomy for mid-upper esophageal cancer.
METHODS     We  retrospectively  reviewed  the  data  of  34  esophageal cancer patients who received Belsey surgery or a modified Ivor-Lewis sur -gery from November 1992 to April 2007. Twenty of the patients underwent a Belsey prodecdure (Group A) from November 1992 to January 2001 and 14
underwent a modified Ivor-Lewis prodecdure (Group B) from May 2001 to April 2007.
RESULTS     Twenty patients with esophageal cancer received an esopha-gectomy through an exclusive right-thoracic approach (Belsey surgery), and 14  patients  received  an  esophagectomy  through  a  right-thoracic  approach combined with a laparotomy (modified Ivor-Lewis surgery). The complica -tion rate was 15% (3/20) and 7.1% (1/14) respectively. The survival rate was 42.9%  (5-year  survival)  and  38.7%  (5-year  survival)  respectively  for  these two groups.
CONCLUSION    An exclusive right-thoracic approach (Belsey surgery) is associated with more complications. It is not a routine surgery for cancer of the mid-upper thorax of the esophagus, but can be selectively used as pal -liative  esophagectomy  for  esophageal  cancer  patients  with  poor  pulmonary function. Modified Ivor-Lewis surgery can simultaneously be utilized to resect the primary tumor and dissect lymph nodes of the thorax and abdomen. With a shorter time period of surgery and postoperative recovery period, modified Ivor-Lewis surgery can achieve better effects with patients who have mid-upper esophagus cancer. 

Keywords


right-thoracic approach, esophageal cancer, Belsey surgery, modified Ivor-Lewis surgery, complication.

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