Upper GI 2017

3/28/2017

TheRoyalMarsden

Endoscopic Resection vs Surgery

Depth of invasion & nodal status

pT1m(1-3)OesophagealACA

ERplus APC

76 38

T Stage (n= 369)

N0

N1

Oesophagectomy

Majorcomplications ER

T1a

147

2 (1.3%)

0%

Surgery

32%

T1b

167

53 (24 %)

90day mortality ER

0%

Total

314

55 (15%)

Surgery

2.6%

4year followup

ER 1patient localrecurrence;4 metachronousneoplasia

– ClarkGWB. OesophagogastricSurgery,GriffinSM&RaimesSA (ed); 1997:p108

Pechetal2001AnnSurg 254:67

9

10

TheRoyalMarsden

TheRoyalMarsden

Aim of Resection

Aim of Resection

Complete resection of primary tumour (R0)

Complete resection of primary tumour (R0)

Clear margins

Clear margins

Lymphadenectomy (>15 nodes)

Lymphadenectomy (>15 nodes)

TheRoyalMarsden

12

Dutch Trial Trans Hiatal Oesophagectomy vs Trans Thoracic Oesophagectomy

5 YEAR SURVIVAL

TTO 39% (CI 30 – 48%)

THO 29% (CI 20 – 38%)

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.

2