The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 876-883, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Twenty-five-year experiences with esophageal transection for esophageal varices
Y Idezuki and K Sanjyo
Second Department of Surgery, University of Tokyo, Faculty of Medicine, Japan.
Results of 287 transthoracoabdominal esophageal transections (Sugiura
procedure), 125 transthoracic esophageal transections, 48 transabdominal
esophageal transections, and 58 other nonshunting operations performed
during the past 25 years were analyzed. Overall operative mortality rate
was 5.0% (26/518); however, it was observed only in patients with liver
cirrhosis (7.0%) and was higher in emergency cases (23.3%) and patients
classified Child C (17.1%). Two hundred two patients died during the
follow-up period, which lasted 24 years; 33 patients died of rebleeding, 89
of hepatic failure, 65 of hepatoma, and 35 of other causes. Cumulative
survival rates of patients after non-shunting operations differed
significantly according to the nature of the original diseases and the
severity of liver damage. The cumulative survival rate at 10 years in
patients with extrahepatic portal obstruction was 90.7%, 77.6% in
idiopathic portal hypertension, and 33.0% in liver cirrhosis and at 20
years, 85.6%, 37.9%, and 8.1% respectively. The cumulative survival rate at
5 years in patients classified Child A was 88.7%, 77.7% in Child B, and
39.5% in Child C, and at 10 years, 73.4%, 45.3%, and 14.1%, respectively.
Esophageal transection can be performed safely and is recommended in
patients classified Child A or B. Patients in Child C should be treated by
endoscopic sclerotherapy and other conservative measures.
