Background: Esophageal resections for early distal cancer may be performed as limited resections with jejunal interposition. For long, subtotal resection and cervical gastric pull-up has been the mainstay of reconstruction.
Patients and Methods: Between 2000 and 2004, 18 patients underwent limited resection of the distal esophagus and the cardia for early adenocarcinoma and were compared to 72 patients with subtotal esophagectomy.
Results: Subtotal and limited esophageal resections are depicted in the table. 10/72 subtotal and 2/18 limited resections displayed pN1 status (13.9 and 11.1%, respectively, p=1.00, Fisher's exact test) and the mean nodal surgical retrieval was 25 and 15 lymph nodes, respectively. At a median observation time of 38.9 and 31.1 months, 33/72 and 16/18 patients survived, respectively (p=0.050, Kaplan-Meier model, log-rank test). 9/72 subtotal esophagectomies were followed by anastomotic postoperative leak, whereas leak was not observed in the other group (chi-square p= 0.11). Perioperative deaths occurred exclusively in the subtotal esophagectomy group (4/72, 5.7%).
Conclusions: Limited resection is a less traumatizing alternative and might be equally effective in terms of local tumor control in patients with early cancer without nodal metastases.
| P=0.030* | Resections: | subtotal | limited | Total No. |
| Histopathology: | ||||
| Carcinoma only in endoscopical biopsy | No. (%) | 7 (9.7%) | 5 (27.8%) | 12 (13.3%) |
| HGIEN | No. (%) | 1 (1.4%) | 2 (11.1%) | 3 (3.3%) |
| pT1a | No. (%) | 17 (23.6%) | 3 (16.7%) | 75 (22.2%) |
| pT1b | No. (%) | 47 (65.3%) | 8 (44.4%) | 55 (61.1%) |
| Total No. | No. (%) | 72 (100%) | 18 (100%) | 90 (100%) |
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