Esophagus Surgery

Large gastroenterological clinics in Germany provide comprehensive treatment of patients with the digestive system disorders. Specialists of the Department of “General and Visceral Surgery” focus their attention on a variety of therapeutic and surgical methods of overcoming esophagus cancer.

Surgery on the esophagus is a highly complex procedure that places high demands on both the surgeon and the entire treatment team in the course of pre-, peri- and post-operative care. It has been known for many years that there is a strong connection between the number of hospital cases and the treatment results in esophageal surgery. Meta-analyzes of international studies showed that the more often the operation is carried out in a hospital, the lower the hospital mortality after esophageal interventions, which are carried out due to malignant neoplasm. A recent work from Germany confirmed this connection for interventions in esophageal carcinoma and showed that these procedures in Germany are often carried out by hospitals with very small numbers of cases.

The number of treatment cases with complex intervention on the esophagus was 3,598 in 2015 and rose to 4,032 by 2019. The number of hospitals in which such interventions were carried out fluctuated over time and was 406 in 2019. The median number of complex esophageal interventions per hospital and year increased from five to six in the observation period. This means that in 2019, half of the hospitals that underwent esophageal surgery performed a maximum of six procedures.

Malignant neoplasms were most often coded as the underlying disease. In 2019 (2015), malignant neoplasms of the esophagus and 9% (11%) malignant neoplasms of neighboring organs or secondary malignant neoplasms were encoded in 83% (81%) of the treatment cases.

The proportion of total esophageal resections fluctuated between 48% and 52%, with the proportion of total resections with abdominocervical access decreasing from 13% in 2015 to 6% in 2019.

The proportion of patients aged 65 years or older was higher in hospitals with a low benefit rate (57% in the lower case quintile) than in hospitals with a high benefit rate (46% in the upper case quintile).

As the underlying disease, malignant neoplasms in the lower case quintile were less common than in the upper case quintile (74% versus 89%), while malignant neoplasm of neighboring organs was coded more often (16% versus 5%).

In relation to the type of surgery, the proportion of total esophageal resections in the lower case quintile was lower (30%) than in the upper case quintile (70%) and the proportion of partial resections was higher (59% versus 23%). Gastrectomies with subtotal esophageal resection accounted for 10% of the patients in the lower case quintile and 5% in the upper.

In terms of total esophageal resection, the proportion of abdominocervical access procedures was higher in hospitals with a low benefit rate than in hospitals with a high benefit rate (lower case number quintile 13% versus upper case number quintile 6%).

The primary stages of cancer are usually characterized by the absence of obvious symptoms, including pain. As a rule, at this stage the tumor does not exceed 3 cm and does not affect the surrounding organs and tissues. Endoscopic esophagus surgery is the most effective method of dealing with early forms of cancer. Esophagus surgery with the endoscopic laser effectively eliminates the first metastases. Such esophagus surgery includes qualitative visual accompaniment that allows professionals to carefully monitor every step. The laser energy locally and accurately burns the abnormal area. Laser esophagus surgery perfectly closes wounds, does not allow blood loss and proliferation of cancer cells.

In the later stages of cancer cells proliferation, the physicians of Schwarzwald-Baar Clinic use radical methods of treatment, which are aimed at saving as many healthy parts of the esophagus as possible.

Esophagus surgery is carried out after completion of chemotherapy. This regimen is provided for additional attenuation of the tumor, its reduction in size and the possibility to stop its further progression. Chemotherapy is often used as an independent method, which completely defeats even squamous cell carcinoma.

Radical esophagus surgery starts with formation of a path towards the pathological area in the abdominal and thoracic cavity. All esophageal cavity is neatly separated from the adjacent tissues. Later in the course of esophagus surgery the affected organ is replaced by a part of the colon or intestinal segment. Resection esophagus surgery can last up to 5 hours. The rehabilitation period takes approximately 1 month.

Benign tumors of the esophagus may eventually become malignant, so do not delay their treatment. Optimal method for achieving the best results is laparoscopic esophagus surgery. The essence of laparoscopic esophagus surgery is to create several millimetric punctures, through which video-device and minimally invasive instruments are inserted. The physicians try to remove the tumor from the esophageal tube, the tumor is located in a dense capsule and has not had time to germinate in the mucosal tissues. This esophagus surgery does not injure the soft tissues of the body, practically excludes blood loss, retains the aesthetic appearance (no visible scars), as well as prevents the re-emergence of pathology.

Due to the innovative conditions of the Schwarzwald-Baar Clinical Center, esophagus surgery is performed in accordance with the new European trends and standards. To ensure the safety and reliability of surgical procedures is the main goal of the wide-profile clinic.

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