title: Two-stage operation for high-risk patients with thoracic esophageal cancer: an old operation revisited.
abstract: OBJECTIVE
  An esophagectomy followed by reconstruction for esophageal cancer is a highly aggressive operation. The purpose of this study was to justify a two-stage operation for high-risk patients with esophageal cancer.
  
  
  METHODS
  The clinical results of 27 patients who underwent two-stage operation were compared with 118 patients who underwent a simultaneous resection and reconstruction (control subjects). The reasons for the selection of the two-stage operation were underlying general disease in 13 patients (liver dysfunction, n = 6; pulmonary disease, n = 3; poor performance status, n = 2; diabetes and renal failure, n = 1 each) and high-risk operation in 14 other patients (colon interposition, n = 7; salvage operation after definitive chemoradiotherapy, n = 4; and intraoperative events, n = 3). The patients initially underwent an esophagectomy and a cervical esophagostomy. Reconstruction was usually performed 2-3 weeks later.
  
  
  RESULTS
  The patients in the two-stage group were older than the control patients (mean 67.8 vs. 61.6 years old). The morbidity rate of the two-stage operation was 29.6%, which was not statistically different than control patients (32.2%). Postoperative complications in the two-stage operation were anastomotic leakage in 5 patients, and pneumonia and wound infection in 1 patient each. No patient experienced in-hospital death. The survival rates were not statistically different between the two groups.
  
  
  CONCLUSIONS
  A two-stage operation is a safe operation that prevents the occurrence of critical postoperative complications, and it thus may be considered an important treatment strategy for high-risk patients with esophageal cancer.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. masarum@surg2.med.kyushu-u.ac.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Tomonori
authors.initials: T
authors.lastname: Nakanoko
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Kubo
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Fujinaka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ikeda
authors.forename: Akinori
authors.initials: A
authors.lastname: Egashira
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Takefumi
authors.initials: T
authors.lastname: Ohga
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Shunichi
authors.initials: S
authors.lastname: Tsujitani
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome