Two-stage operation for high-risk patients with thoracic esophageal cancer: An old operation revisited

Masaru Morita, Tomonori Nakanoko, Nobuhide Kubo, Yoshihiko Fujinaka, Keisuke Ikeda, Akinori Egashira, Hiroshi Saeki, Hideaki Uchiyama, Takefumi Ohga, Yoshihiro Kakeji, Ken Shirabe, Tetsuo Ikeda, Shunichi Tsujitani, Yoshihiko Maehara

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Purpose: An esophagectomy followed by reconstruction for esophageal cancer is a highly aggressive operation. The purpose of this study was to justify a two-stage operation for high-risk patients with esophageal cancer. Methods: The clinical results of 27 patients who underwent two-stage operation were compared with 118 patients who underwent a simultaneous resection and reconstruction (control subjects). The reasons for the selection of the two-stage operation were underlying general disease in 13 patients (liver dysfunction, n = 6; pulmonary disease, n = 3; poor performance status, n = 2; diabetes and renal failure, n = 1 each) and high-risk operation in 14 other patients (colon interposition, n = 7; salvage operation after definitive chemoradiotherapy, n = 4; and intraoperative events, n = 3). The patients initially underwent an esophagectomy and a cervical esophagostomy. Reconstruction was usually performed 2-3 weeks later. Results: The patients in the two-stage group were older than the control patients (mean 67.8 vs. 61.6 years old). The morbidity rate of the two-stage operation was 29.6%, which was not statistically different than control patients (32.2%). Postoperative complications in the two-stage operation were anastomotic leakage in 5 patients, and pneumonia and wound infection in 1 patient each. No patient experienced in-hospital death. The survival rates were not statistically different between the two groups. Conclusion: A two-stage operation is a safe operation that prevents the occurrence of critical postoperative complications, and it thus may be considered an important treatment strategy for high-risk patients with esophageal cancer.

Original languageEnglish
Pages (from-to)2613-2621
Number of pages9
JournalAnnals of Surgical Oncology
Issue number9
Publication statusPublished - Sept 2011

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology


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