José Luis Braga de Aquino

By José Luis Braga de Aquino and Vânia Aparecida Leandro-Merhi

Of the several procedures that has to treat esophageal achalasia, the esophagectomy is to be the most indicated in advanced disease, which prompted Pinotti the disseminate the transmediastinal esophagectomy technique in the 1970s, with the advantage of avoiding thoracotomy. Nevertheless, several series demonstrated that this technique was not exempt from complications one of which could lead to massive hemopneumothorax due to injury to the trachea- bronchial tree and vessels due the periesophagitis that may be present with consequent adherence of the esophagus to these noble organs. Thus, Aquino in 1996 introduced the esophageal mucosectomy technique with preservation of the esophageal muscle tunic at the level of mediastinum as well as the transposition of the stomach to the cervical region inside in this tunic for the reconstruction of digestive tract. The advantage of this procedure is to avoid transgression of the mediastinum. This author describes in details this procedure, and shows early results and late evaluation using the ECKARDT score in a series of patients showing the advantages of the esophageal mucosectomy due the low incidence of immediate postoperative complications and good resolution in long term due the absence of symptoms in most patients.

Part of the book: Dysphagia

By José Luis Braga de Aquino and Vânia Aparecida Leandro-Merhi

Even through the esophageal cancer has innumerable treatment options, its prognosis is still unsettled. Because esophagectomy is rarely curative, others therapies, such as chemoradiation emerging in advanced disease followed or not surgery. The salvage esophagectomy is an alternative for those patients with recurrent disease. Thus in this chapter the intend is show the results of the salvage esophagectomy in patients with esophageal cancer who had previously undergone chemoradiation and discussion about the morbidity of this surgical tecnic. Too, its show the our experience in 72 patients with unresectabeled esophageal carcinoma were treated with chemorradiation followed by salvage esophagectomy by trans-toracic approach. Patients was evaluated with regard pos-operative complications and disease free survival. The major complications was deiscence at the level of the of the anastomosis esophagogastric cervical, presents in 16 patients (22,2%) and pulmonar infection in 23 patients (31,9%). In 53 patients that were available for a five years follow-up, was a rate of 43,3% (23 patients) of disease free survival. Thus with the results its conclude that the salvage esophagectomy seems to be valuable in cases without any other therapeutic options.

Part of the book: Esophageal Surgery

By Jose Luis Braga De Aquino and Vania Aparecida Leandro-Merhi

Although malignant neoplasms of the esophagus remain a very common disease, their diagnosis might often come late, which explains why 50% of patients require palliative treatment. The ideal scenario would be the performance of procedures that provided an adequate quality of life and satisfactorily restored swallowing. This chapter aims to describe the results of palliative methods, discussed with emphasis on the technique of the isoperistaltic greater curvature gastric tube (IGCGT). About 143 patients with unresectable squamous cell carcinoma of the esophagus (T4b) were evaluated at this facility. In the early postoperative evaluation, 64 patients (44.7%) presented systemic complications, with pulmonary infection being the most frequent; 51 patients (35.6%) presented local complications, with cervical esophagogastric anastomosis leak being the most frequent. Thirteen patients (9.1%) died as a result of postoperative complications. Out of 112 patients who were adequately followed up, 91 (81.2%) achieved good palliation with this procedure, as they had adequate restoration of swallowing function, with a median survival of 3 years in 63 patients (69.2%). With these results, it is possible to conclude that despite showing non-negligible morbidity, IGCGT can be performed quickly and safely, offering adequate palliation and survival rate.

Part of the book: Palliative Care - Current Practice and Future Perspectives [Working title]