Esophagectomy combined with aortic segment replacement for esophageal cancer invading the aorta

Background: Surgical treatment for patients with esophageal carcinoma that invades the aorta locally (stage IIIc) remains a considerable challenge. This study aimed to introduce radical esophagectomy combined with off-pump descending aorta replacement in these patients and to assess the effects on both short-term and long-term outcomes.

Methods: The clinical data of 47 patients who had esophageal carcinoma invading the descending aorta and who underwent radical esophagectomy combined with off-pump aortic replacement between January 2001 and March 2012 in Jinling Hospital were retrospectively reviewed. The intraoperative, early postoperative, and follow-up results were analyzed.

Results: Overall, 80.9% and 19.1% of the patients had histopathologically confirmed aortic tunica adventitia invasion and media invasion, respectively. All patients received complete resection (R0) with an average intraoperative blood loss of 227.6±63.3 mL. The mean operative time and aortic cross-clamping time were 4.9±1.3 hours and 17.0±3.2 minutes, respectively. Complications were observed in 59.6% of patients, with no hospital mortality, and all patients resumed an oral diet 1 month after the procedure. The overall 1-, 3-, and 5-year survival rates were 80.9%, 44.7%, and 21.3%, respectively, with a median survival time of 33.6 months.

Conclusions: In patients with esophageal carcinoma invading the aorta, it is feasible and safe to perform radical esophagectomy combined with off-pump descending aorta replacement to improve nutritional status and achieve satisfactory survival.