|Vagal Sparing Esophagectomy: The Ideal Operation For High Grade Dysplasia and Early Esophageal Cancer|
|Christian G Peyre*, Steven R DeMeester, Christian Rizzetto*, Neeraj Bansal*, Andrew L Tang*, Shahin Ayazi*, Jessica M Leers*, John C Lipham*, Jeffrey A Hagen, Tom R DeMeester |
University of Southern California, Los Angeles, CA
|OBJECTIVE: Esophagectomy is curative for most patients with high grade dysplasia (HGD) or intramucosal esophageal carcinoma (IMC), but is associated with significant early and late morbidity. A vagal-sparing esophagectomy (VSE) minimizes the physiologic impact and offers the potential for reduced morbidity of esophageal resection. The aim of this study is to compare the outcome of VSE to other types of esophagectomy for patients with HGD or IMC.|
METHODS: Retrospective record review of all patients who underwent a vagal-sparing, transhiatal, or en-bloc esophagectomy for HGD or IMC from 1987-2006.
RESULTS: A total of 128 patients were analyzed. Indication for operation was IMC in 43% of VS, 85.4% of TH and 100% of EB. Hospital data and outcome are listed in the table. Cancer recurrence at a median follow-up of 37, 18 and 59 months respectively, has been 1/35 patients after VS, 2/44 after TH, and 2/24 after EB.
CONCLUSIONS: A vagal-sparing esophagectomy has significantly less early morbidity including fewer anastomotic and pulmonary complications and a shorter hospital stay than a transhiatal or en-bloc esophagectomy. Further, late morbidity including weight loss, dumping, and diarrhea are significantly reduced after a vagal-sparing approach. As cancer recurrence rates were similar for the different procedures, a vagal-sparing resection should be the esophagectomy of choice for patients with high grade dysplasia and intramucosal carcinoma.
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