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2
Depth of invasion & nodal status
– ClarkGWB. OesophagogastricSurgery,GriffinSM&RaimesSA (ed); 1997:p108
T Stage
(n=
369)
N0
N1
T1a
147
2 (1.3%)
T1b
167
53 (24 %)
Total
314
55 (15%)
TheRoyalMarsden
Endoscopic Resection vs Surgery
pT1m(1-3)OesophagealACA
ERplus APC
76
Oesophagectomy
38
Majorcomplications
ER
0%
Surgery
32%
90day mortality
ER
0%
Surgery
2.6%
4year followup
ER 1patient localrecurrence;4 metachronousneoplasia
Pechetal2001AnnSurg 254:67
TheRoyalMarsden
Aim of Resection
Complete resection of primary tumour (R0)
Clear margins
Lymphadenectomy (>15 nodes)
9
TheRoyalMarsden
Aim of Resection
Complete resection of primary tumour (R0)
Clear margins
Lymphadenectomy (>15 nodes)
10
TheRoyalMarsden
Dutch Trial
Trans Hiatal Oesophagectomy vs Trans Thoracic
Oesophagectomy
220 patients with mid and lower oesophageal ACA
THO
Lower morbidity
TTO
More nodes
More respiratory complications
Hulscher et lN Engl J Med 2002;347:1662-9.
12
5 YEAR SURVIVAL
TTO 39% (CI 30 – 48%)
THO 29% (CI 20 – 38%)