Table 35.
Malignant Esophageal disease
| Operation ( +) | Thoracoscopic and/or laparscopic procedure | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Cases | Hospital mortality | Cases | Conversion to thoracotomy | Hospital mortality | |||||
| ~ 30days | 31–90days | Total (including after 91days mortality) | ~ 30days | 31–90days | Total (including after 91days mortality) | ||||
| Location | |||||||||
| (1) Cervical esophagus | 118 | 2 (1.7) | 0 | 2 (1.7) | 51 | 1 (2.0) | 1 (2.0) | 0 | 1 (2.0) |
| (2) Thoracic esophagus | 4181 | 27 (0.6) | 18 (0.4) | 45 (1.1) | 3788 | 19 (0.5) | 23 (0.6) | 15 (0.4) | 38 (1.0) |
| (3) Abdominal esophagus | 436 | 4 (0.9) | 2 (0.5) | 6 (1.4) | 361 | 2 (0.6) | 3 (0.8) | 2 (0.6) | 5 (1.4) |
| Total | 4735 | 33 (0.7) | 20 (0.4) | 53 (1.1) | 4200 | 22 (0.5) | 27 (0.6) | 17 (0.4) | 44 (1.0) |
| Tumor depth | |||||||||
| (A) Superficial cancer(T1) | |||||||||
| (1) Transhiatal esophagectomy | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (2) Mediastinoscopic esophagectomy and reconstruction | 103 | 0 | 1 (1.0) | 1 (1.0) | 103 | 0 | 0 | 1 | 1 (1.0) |
| (3) Transthoracic (rt.) esophagectomy and reconstruction | 1124 | 6 (0.5) | 5 (0.4) | 11 (1.0) | 1043 | 4 (0.4) | 6 (0.6) | 5 (0.5) | 11 (1.1) |
| (4) Transthoracic (lt.) esophagectomy and reconstruction | 31 | 0 | 0 | 0 | 26 | 0 | 0 | 0 | 0 |
| (5) Cervical esophageal resection and reconstruction | 25 | 2 (8.0) | 0 | 2 (8.0) | 0 | 0 | 0 | 0 | 0 |
| (6) Robot-assisted esophagectomy and reconstruction | 424 | 1 (0.2) | 0 | 1 (0.2) | 423 | 0 | 1 (0.2) | 0 | 1 (0.2) |
| (7) Others | 17 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (8) Esophagectomy without reconstruction | 119 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| subtotal | 1847 | 9 (0.5) | 6 (0.3) | 15 (0.8) | 1595 | 4 (0.3) | 7 (0.4) | 6 (0.4) | 13 (0.8) |
| (B)Advanced cancer(T2-T4) | |||||||||
| (1) Transhiatal esophagectomy | 7 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (2) Mediastinoscopic esophagectomy and reconstruction | 129 | 0 | 1 (0.8) | 1 (0.8) | 129 | 0 | 0 | 1 (0.8) | 1 (0.8) |
| (3) Transthoracic (rt.) esophagectomy and reconstruction | 2099 | 17 (0.8) | 10 (0.5) | 27 (1.3) | 1791 | 18 (1.0) | 14 (0.8) | 7 (0.4) | 21 (1.2) |
| (4) Transthoracic (lt.) esophagectomy and reconstruction | 58 | 1 (1.7) | 0 | 1 (1.7) | 33 | 0 | 0 | 0 | 0 |
| (5) Cervical esophageal resection and reconstruction | 52 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (6) Robot-assisted esophagectomy and reconstruction | 644 | 6 (0.9) | 3 (0.5) | 9 (1.4) | 643 | 0 | 6 (0.9) | 3 (0.5) | 3 (0.5) |
| (7) Others | 18 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (8) Esophagectomy without reconstruction | 139 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Subtotal | 3146 | 24 (0.8) | 14 (0.4) | 38 (1.2) | 2596 | 18 (0.7) | 20 (0.8) | 11 (0.4) | 25 (1.0) |
| Total | 4993 | 33 (0.7) | 20 (0.4) | 53 (1.1) | 4191 | 22 (0.5) | 27 (0.6) | 17 (0.4) | 38 (0.9) |
| Cases | Overall morbidity | Morbidity ≥ CD III | Surgical complications | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Surgical site infection | Anastomotic leakage | Recurrent nerve palsy | Wound dehiscence | ||||||
| Superficial incision | Deep incision | Organ space | |||||||
| Location | |||||||||
| (1) Cervical esophagus | 118 | 61 (51.7) | 29 (24.6) | 10 (8.5) | 5 (4.2) | 11 (9.3) | 15 (12.7) | 17 (14.4) | 3 (2.5) |
| (2) Thoracic esophagus | 4181 | 2340 (56.0) | 968 (23.2) | 272 (6.5) | 143 (3.4) | 316 (7.6) | 532 (12.7) | 594 (14.2) | 45 (1.1) |
| (3) Abdominal esophagus | 436 | 215 (49.3) | 96 (22.0) | 24 (5.5) | 13 (3.0) | 41 (9.4) | 57 (13.1) | 45 (10.3) | 3 (0.7) |
| Total | 4735 | 2616 (55.2) | 1093 (23.1) | 306 (6.5) | 161 (3.4) | 368 (7.8) | 604 (12.8) | 656 (13.9) | 51 (1.1) |
| Tumor depth | |||||||||
| (A)Superficial cancer(T1) | |||||||||
| (1) Transhiatal esophagectomy | 4 | 1 (25.0) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (2) Mediastinoscopic esophagectomy and reconstruction | 103 | 64 (62.1) | 31 (30.1) | 7 (6.8) | 3 (2.9) | 13 (12.6) | 23 (22.3) | 28 (27.2) | 0 |
| (3) Transthoracic (rt.) esophagectomy and reconstruction | 1124 | 619 (55.1) | 217 (19.3) | 63 (5.6) | 34 (3.0) | 80 (7.1) | 161 (14.3) | 153 (13.6) | 10 (0.9) |
| (4) Transthoracic (lt.) esophagectomy and reconstruction | 31 | 12 (38.7) | 7 (22.6) | 4 (12.9) | 1 (3.2) | 1 (3.2) | 2 (6.5) | 3 (9.7) | 0 |
| (5) Cervical esophageal resection and reconstruction | 25 | 12 (48.0) | 7 (28.0) | 3 (12.0) | 0 | 1 (4.0) | 1 (4.0) | 4 (16.0) | 0 |
| (6) Robot-assisted esophagectomy and reconstruction | 424 | 200 (47.2) | 85 (20.0) | 20 (4.7) | 11 (2.6) | 27 (6.4) | 53 (12.5) | 53 (12.5) | 2 (0.5) |
| (7) Others | 17 | 4 (23.5) | 2 (11.8) | 1 (5.9) | 1 (5.9) | 3 (17.6) | 4 (23.5) | 4 (23.5) | 0 |
| (8) Esophagectomy without reconstruction | 119 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Subtotal | 1847 | 912 (49.4) | 349 (18.9) | 98 (5.3) | 50 (2.7) | 125 (6.8) | 244 (13.2) | 245 (13.3) | 12 (0.6) |
| (B) Advanced cancer (T2–T4) | |||||||||
| (1) Transhiatal esophagectomy | 7 | 4 (57.1) | 1 (14.3) | 1 (14.3) | 0 | 0 | 0 | 0 | 0 |
| (2) Mediastinoscopic esophagectomy and reconstruction | 129 | 76 (58.9) | 28 (21.7) | 14 (10.9) | 2 (1.6) | 4 (3.1) | 15 (11.6) | 26 (20.2) | 0 |
| (3) Transthoracic (rt.) esophagectomy and reconstruction | 2099 | 1213 (57.8) | 529 (25.2) | 144 (6.9) | 84 (4.0) | 173 (8.2) | 263 (12.5) | 271 (12.9) | 35 (1.7) |
| (4) Transthoracic (lt.) esophagectomy and reconstruction | 58 | 24 (41.4) | 7 (12.1) | 2 (3.4) | 2 (3.4) | 4 (6.9) | 3 (5.2) | 4 (6.9) | 0 |
| (5) Cervical esophageal resection and reconstruction | 52 | 33 (63.5) | 13 (25.0) | 5 (9.6) | 4 (7.7) | 5 (9.6) | 8 (15.4) | 12 (23.1) | 2 (3.8) |
| (6) Robot-assisted esophagectomy and reconstruction | 644 | 345 (53.6) | 160 (24.8) | 41 (6.4) | 19 (3.0) | 53 (8.2) | 66 (10.2) | 102 (15.8) | 2 (0.3) |
| (7) Others | 18 | 9 (50.0) | 6 (33.3) | 1 (5.6) | 0 | 4 (22.2) | 5 (27.8) | 0 | 0 |
| (8) Esophagectomy without reconstruction | 139 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| subtotal | 3146 | 1704 (54.2) | 744 (23.6) | 208 (6.6) | 111 (3.5) | 243 (7.7) | 360 (11.4) | 415 (13.2) | 39 (1.2) |
| Total | 4993 | 2616 (52.4) | 1093 (21.9) | 306 (6.1) | 161 (3.2) | 368 (7.4) | 604 (12.1) | 660 (13.2) | 51 (1.0) |
| Cases | Nonsurgical complications | Readmission within 30d | Reoperation within 30d | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pneumonia | Unplanned intubation | Prolonged ventilation > 48 h | Pulmonary embolism | Atelectasis | Renal failure | CNS events | Cardiac events | Septic shock | ||||
| Location | ||||||||||||
| (1) Cervical esophagus | 118 | 14 (11.9) | 7 (5.9) | 13 (11.0) | 1 (0.8) | 3 (2.5) | 1 (0.8) | 2 (1.7) | 0 | 1 (0.8) | 15 (12.7) | |
| (2) Thoracic esophagus | 4181 | 670 (16.0) | 162 (3.9) | 166 (4.0) | 39 (0.9) | 187 (4.5) | 16 (0.4) | 16 (0.4) | 18 (0.4) | 29 (0.7) | 104 (2.5) | 246 (5.9) |
| (3) Abdominal esophagus | 436 | 50 (11.5) | 10 (2.3) | 18 (4.1) | 6 (1.4) | 27 (6.2) | 3 (0.7) | 2 (0.5) | 1 (0.2) | 4 (0.9) | 5 (1.1) | 25 (5.7) |
| Total | 4735 | 734 (15.5) | 179 (3.8) | 197 (4.2) | 46 (1.0) | 217 (4.6) | 19 (0.4) | 19 (0.4) | 21 (0.4) | 33 (0.7) | 110 (2.3) | 286 (6.0) |
| Tumor depth | ||||||||||||
| (A) Superficial cancer (T1) | ||||||||||||
| (1) Transhiatal esophagectomy | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (2) Mediastinoscopic esophagectomy and reconstruction | 103 | 13 (12.6) | 3 (2.9) | 4 (3.9) | 1 (1.0) | 4 (3.9) | 0 | 0 | 2 (1.9) | 1 (1.0) | 3 (2.9) | 5 (4.9) |
| (3) Transthoracic (rt.) esophagectomy and reconstruction | 1124 | 163 (14.5) | 42 (3.7) | 37 (3.3) | 5 (0.4) | 51 (4.5) | 2 (0.2) | 7 (0.6) | 4 (0.4) | 8 (0.7) | 23 (2.0) | 68 (6.0) |
| (4) Transthoracic (lt.) esophagectomy and reconstruction | 31 | 4 (12.9) | 1 (3.2) | 1 (3.2) | 0 | 3 (9.7) | 1 (3.2) | 0 | 0 | 0 | 1 (3.2) | 2 (6.5) |
| (5) Cervical esophageal resection and reconstruction | 25 | 5 (20.0) | 2 (8.0) | 2 (8.0) | 0 | 1 (4.0) | 0 | 0 | 0 | 1 (4.0) | 0 | 3 (12.0) |
| (6) Robot-assisted esophagectomy and reconstruction | 424 | 57 (13.4) | 10 (2.4) | 12 (2.8) | 6 (1.4) | 13 (3.1) | 0 | 1 (0.2) | 1 (0.2) | 1 (0.2) | 11 (2.6) | 31 (7.3) |
| (7) Others | 17 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 (5.9) | 2 (11.8) |
| (8) Esophagectomy without reconstruction | 119 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| subtotal | 1847 | 242 (13.1) | 58 (3.1) | 56 (3.0) | 12 (0.6) | 72 (3.9) | 3 (0.2) | 8 (0.4) | 7 (0.4) | 11 (0.6) | 39 (2.1) | 111 (6.0) |
| (B)Advanced cancer (T2–T4) | ||||||||||||
| (1) Transhiatal esophagectomy | 7 | 2 (28.6) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| (2) Mediastinoscopic esophagectomy and reconstruction | 129 | 25 (19.4) | 2 (1.6) | 3 (2.3) | 1 (0.8) | 8 (6.2) | 0 | 0 | 1 (0.8) | 0 | 4 (3.1) | 3 (2.3) |
| (3) Transthoracic (rt.) esophagectomy and reconstruction | 2099 | 354 (16.9) | 91 (4.3) | 106 (5.1) | 23 (1.1) | 101 (4.8) | 11 (0.5) | 9 (0.4) | 10 (0.5) | 14 (0.7) | 50 (2.4) | 130 (6.2) |
| (4) Transthoracic (lt.) esophagectomy and reconstruction | 58 | 8 (13.8) | 3 (5.2) | 3 (5.2) | 0 | 2 (3.4) | 1 (1.7) | 0 | 0 | 1 (1.7) | 1 (1.7) | 2 (3.4) |
| (5) Cervical esophageal resection and reconstruction | 52 | 5 (9.6) | 4 (7.7) | 5 (9.6) | 1 (1.9) | 0 | 0 | 0 | 0 | 0 | 0 | 5 (9.6) |
| (6) Robot-assisted esophagectomy and reconstruction | 644 | 96 (14.9) | 21 (3.3) | 24 (3.7) | 9 (1.4) | 33 (5.1) | 4 (0.6) | 2 (0.3) | 1 (0.2) | 7 (1.1) | 17 (2.6) | 35 (5.4) |
| (7) Others | 18 | 2 (11.1) | 0 | 0 | 0 | 1 (5.6) | 0 | 0 | 2 (11.1) | 0 | 0 | 0 |
| (8) Esophagectomy without reconstruction | 139 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Subtotal | 3146 | 492 (15.6) | 121 (3.8) | 141 (4.5) | 34 (1.1) | 145 (4.6) | 16 (0.5) | 11(0.3) | 22 (0.7) | 72 (2.3) | 175 (5.6) | |
| Total | 4993 | 734 (14.7) | 179 (3.6) | 197 (3.9) | 46 (0.9) | 217 (4.3) | 19 (0.4) | 19 (0.4) | 21 (0.4) | 33 (0.7) | 111 (2.2) | 286 (5.7) |