Chapters authored
Surgical Treatment of Esophageal Advanced Achalasia
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
Salvage Esophagectomy in Advanced Esophageal Cancer
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