Is the surgical stress associated with worse survival in patients with esophageal cancer?--Analysis of colon substitution for 37 patients with remnant stomach.
OBJECTIVE
Colon substitution is a standard method of reconstruction, although an aggressive surgery, for patients with esophageal carcinoma who have remnant stomach. Presence of postoperative complication was reported to be a risk factor for worse survival in the patients with esophageal cancer. We evaluated the affect of this surgical stress on the postoperative course and long-term survival of patients with esophageal carcinoma.


METHODS
Between 1980 and 2002, a total of 37 patients with primary thoracic esophageal squamous cell carcinoma, who had history of gastrectomy due to gastric ulcer, underwent R0 esophagectomy followed by colon substitution (colon group). The clinical affect of colon substitution was retrospectively evaluated in comparison with gastric substitution as the control group (stomach group).


RESULTS
The postoperative hospital morbidity rate was significantly higher in the patients with remnant stomach than in the control group. Although the clinicopathological features in both groups were similar, except operative time and bleeding volume, the overall and cause-specific survival of the remnant stomach group were significantly worse than those of the control group. Multivariate analysis suggested that remnant stomach was an independent risk factor for a worse survival.


CONCLUSIONS
Surgical stress and postoperative complications, resulted by colon substitution for the patients with remnant stomach, might be associated with worse survival of patients with esophageal cancer.
Shimada
Hideaki
H
Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8677, Japan. hshimada@faculty.chiba-u.jp
Okazumi
Shinnichi
S
Matsubara
Hisahiro
H
Nabeya
Yoshihiro
Y
Shiratori
Tooru
T
Hayashi
Hideki
H
Shuto
Kiyohiko
K
Akutsu
Yasunori
Y
Ochiai
Takenori
T
D000368:Aged; D003106:Colon / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D018530:Gastric Stump; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis