HP20 OESOPHAGECTOMY FOR TUMOURS AND DYSPLASIA OF THE OESOPHAGUS AND GASTRO‐OESOPHAGEAL JUNCTION: EXPERIENCE OF A SINGLE SURGEON

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Purpose Neoadjuvant therapy, radical lymphadenectomy and treatment in high volume centres have been proposed to improve outcomes for resectable oesophageal tumours. The aim of our study was to review the outcomes of oesophagectomy performed by a single surgeon with a moderate caseload where surgery was the principal treatment and a conservative lymphadenectomy was performed and compare them with current literature.Methodology The study comprises 125 consecutive cases of attempted oesophagectomy performed by a single surgeon (RC) from 1993–2006. Data has been recorded in a prospective database maintained and updated by the surgeon.Results Endoscopic ultrasound was used in staging 69% of patients. Only 23% patients received neoadjuvant therapy. Resection rate was 97%. There were 121 oesophagectomies performed with a complete R0 resection in 82%. In‐hospital mortality was 0.8%. Clinical anastomotic leak occurred in 1.7%. Median length of stay was 14 days. Overall median and 5 year survival were 46 months and 47%. Stage specific 5 year survival was stage 0 100%, stage I 71%, stage II 41% and stage III 21%. Isolated local recurrence occurred in 8%. Dilatation was required in 15 patients and 3 stents were placed.Conclusion A moderate volume surgeon with specialist training can achieve a low mortality and anastomotic leak rate with good survival outcomes. Surgery remains the principal treatment for resectable oesophageal tumours. The role for neoadjuvant therapy and radical lymphadenectomy is controversial and remains to be clearly defined. Accurate preoperative staging with endoscopic ultrasound is important for selection of patients, determining therapy and comparison of results.