Comparison of Two and Three Stage Esophagectomies for Esophageal Carcinoma: Early Results in A High Output Center

Abstract

Objective: Despite the advancements inmanagement and surgical expertise, esophageal cancer continues to
be the sixth most common cause of cancer related deaths. The aim of study was to compare various variables
of Two-stage and Three-stage esophagectomies leading to the morbidity and mortality.
Methodology: A retrospective cross-sectional study was conducted in Thoracic Surgery Department, JPMC,
Karachi from 2019-2021. All resectable and operatable tumors were included. Data was retrieved from a preformed data sheet and was analyzed using SPSS-22.
Result: A total of 114 patients were included in this study, with 66(57.9%) males. Mean age of presentation
was 45.25±15.32 years. Squamous cell carcinoma was encountered in 75 patients (65.8%). The most common
location of tumor was lower thoracic esophagus (LTE) seen in 66 patients (57.9%) Ivor Lewis esophagectomy
(2 stage) was performed in 69(60.5%) patients, whereas McKeown (three stage) was conducted in 45(39.5%).
Tumor free margins were seen in 111(97.4%). Longer duration (5hrs) of surgery was 62.7% found in McKeown
esophagectomy. Total 30-day mortality was 7.9% (9/114), with respiratory failure as the most common cause.
Overall mortality was 7% (8/114), predominant in two stage esophagectomy. However, major complications
such as anastomotic leak 5.26% (6/114) and early stenosis 29.8% (34/114) were noted in Three stage surgery.
Conclusion: Despite smaller duration of surgery, technical feasibility and low morbidity, two staged
esophagectomy bears comparable mortality as compared to the three staged esophagectomy. However, both
procedures are relatively safe and effective provided accurate indications, patient selection and technical expertise.
Key Words: Anastomotic leak, esophageal carcinoma, ivor lewis esophagectomy, McKeown esophagectomy,
squamous cell, stricture