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Ann Thorac Surg 2002;74:1291-1292
© 2002 The Society of Thoracic Surgeons

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Correspondence

Esophagectomy in elderly patients over 70 years of age

^a Department of Thoracic Surgery, First Hospital, Beijing University, Xishiku Dajie 8, Xicheng Qu, Beijing 100034, The People’s Republic of China

e-mail: ycui3103{at}hotmail.com

To the Editor

Although the article by Fang and associates [1] demonstrated that those patients over 70 years of age with esophagectomy gained "satisfactory" long-term results, three issues should be considered by the authors.

The first issue regards the incidence of esophagogastric leakage. The authors showed that the leak rate of esophagogastric anastomosis is from 26% to 35%. Such a high leak rate, which is usually caused by poor surgical anastomosis technique, would undoubtedly influence statistical studies for short-term and long-term results. Acceptably, the incidence of transthoracic esophagogastric anastomosis leakage should be less than 5%, although a few surgeons may control it within 2%.

The second issue relates to postoperative esophagogastric reflux. Fang and associates had not shown whether postoperative esophagogastric reflux could influence the long-term results. In our animal experiments [2–3], 17% of animals with esophagectomy died of esophagogastric reflux; in some medical centers, about 30% of patients with esophagectomy died of postoperative esophagogastric reflux and not by the recurrence of tumor.

The third issue relates to the significance of cervical lymphadenectomy. In the so-called radical cervical lymphadenectomy, it is hard to reach the link area between neck and thoracic space. In addition, the area of cervical lymphadenectomy is the final destination for tumor lymphatic metastasis. Thus, cervical lymphadenectomy may be a significant factor in patient outcome.

References

1. Fang W., Igaki H., Tachimori Y., Sato H., Daiko H., Kato H. Three-field lymph node dissection for esophageal cancer in elderly patients over 70 years of age. Ann Thorac Surg 2001;72:867-871.[Abstract/Free Full Text]
2. Cui Y., Urschel J.D., Petrelli N.J. Esophagogastric anastomoses in rats. An experimental model. J Invest Surg 1999;12:295-298.[Medline]
3. Cui Y., Urschel J.D. Pulmonary aspiration complicating esophagogastric anastomoses in rats. J Invest Surg 2000;13:71-72.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cui, Y. Articles by Chen, H. Search for Related Content PubMed PubMed Citation Articles by Cui, Y. Articles by Chen, H. Related Collections Esophagus - cancer