Upper GI 2017

3/28/2017

TheRoyalMarsden

Resection Margin and Procedure

OPERATIVE MORBIDITY FOR JUNCTIONAL PROCEDURES

171 AEG Patients

SERIES

PROCEDURE

NO.

OPERATIVE MORTALITY

OPERATIVE MORBIDITY

SPECIFIC MORBIDITY

16 Oesophagectomy 71 Left Thoraco-abdominal 84 Transhiatal

Meyer etal (2002)

TTO LTAExt TG

56 74

5.3% 1.4%

41%

Respiratory

Margin: proximal limit of tumour above junction > 5cm – oesophagectomy 3 – 5cm – left thoraco-abdominal < 3cm - Transhiatal

Lerutet al (2004)

TTO 3 field

174

1.2%

58%

Respiratory 32.8% Arrythmia 10.9%

Internulloet al (2008)

LTA

94 (>75yrs)

7.4%

51.9%

Respiratory37%

Ott etal (2009)

TTO

240

3.8%

17.9%

Respiratory

Liet al (2011)

LTA

135

0%

11%

Respiratory6% Leak 1% Wound Infection 4%

Nakamura et al 2008, Hep Gastr 55: 1332-7

Multimodality treatment of oesophageal cancer

Lymphadenectomy in Oesophago-Gastrectomy

Adenocarcinoma

Squamous cell carcinoma

Definitive Chemo- radiation

Pre-operative chemotherapy

Pre-operative chemotherapy

Pre-operative chemotherapy

Pre-operative chemoradiation

Surgery

Surgery

Surgery

Surgery

Post-operative chemotherapy

Frequency of Nodal Involvement Pedrazzani et al 2007

83

Nodal Distribution in Type II

Siewert et al 2002

Pedrazzani et al 2007

14