A Comparative Study on Three Operative Procedures for the Treatment of Esophageal Cancer in Shohada Tajrish Medical Center During the Years 1991-1999

Considering the high incidence and mortality rate of esophageal cancer in some areas of the country, and its diagnosis at a time of advanced growth, this study was carried out to determine the predisposing factors and the most effective and applicable surgical procedure. In this descriptive study, 158 patients (95 males and 63 females) with esophageal cancer were studied. They referred to Shohada Tajrish hospital during the years 1991- 1999. The highest incidence rate was for patients at an age range of 40-60 years. The main cause of refer was dysphagia and then weight loss and etc. In 66 out of the patients, the tumor was in the middle third of esophagus and in 92 cases, it was in the lower third region. For treatment, 48, 40, and 42 of patients were operated by the methods Ivor-Lewis, Mckeown, and Oringer respectively. In 28 of cases, there existed unremovable tumor and for them, gastrostomy was performed. In the remaining 13 patients, other operations such as Akyama and colon interposition were carried out. Out of 130 operated patients, 18 cases of post-operative decease existed, that is 11 cases for Ivor-Lewis method (16.6%), 5 cases for Mckeown method (28.5%), and 2 cases for Oringer method (8.3%). For the incidence of complications, the most prevalent and premature consequence was pleural effusion ( 16% ), and the most common and late developing consequence was anastomosis constricture (17.8%). In addition, there existed 8 cases (7.15%) of anastomosis leak (5 cases for Ivor-Lewis, 2 cases for Mckeown, and 1 case for Oringer). Other complications in order of incidence were pneumonia (10.7%), in situ infection (8.9%), ampim (7.1%), cardiac complications (3.5%), and ARDS (1.7%). It is concluded that Ivor-Lewis method is followed by the highest incidence of complications. Meanwhile, most of the patients left the hospital 10 days after operation and the least time of hospitalization was for Oringer method.