Upper GI Surgery

Question 1

What are the 30 day and 5 year mortalities of open oesophagectomy?

Answer 1

10% & 75% respectively

Question 2

What are the main subtypes of cancer involved at the oesophagus?

Answer 2

• Adenocarcinoma (typically lower)
• Squamous cell carcinoma (typically upper)

Question 3

What are the risk factors for developing Oes-Ca?

Answer 3

• Poverty
• Smoking
• Alcohol consumption
• Poor nutrition
• Achalasia + Plummer vinson syndrome (SCC specifically)
• Barrett’s oesophagus (AC specifically)

Question 4

What percentage of patients undergo oesophagectomy for curative reasons?

Answer 4

Typically one third will aim for a curative therapy.

Question 5

What are the surgical approaches for oesophagectomy?

Answer 5

• Left or right transthoracic
  
  • Right thoracic + laparotomy (classic Ivor-Lewis approach) -> upper 2/3rds
• Trans-hiatal
  
  • Involves laparotomy and neck incision
  • Generally used in palliative cases, or where thorocotomy is iladvised