Long-term results of esophageal transection and devascularization procedure in treatment of esophageal variceal bleeding.

Fifty-three patients with bleeding esophageal varices received a non-shunting operation--esophageal transection and devascularization of the proximal stomach with splenectomy--from March 1977 to October 1986. The ages of these patients ranged from 26 to 69 years with a mean of 49.70 +/- 10.03 years (+/- SD). Thirty-six patients were male and 17 were female. The pathology of the liver was post-necrotic liver cirrhosis in 39 cases, alcoholic liver cirrhosis in seven cases, liver cirrhosis with hepatocellular carcinoma in six cases and non-cirrhotic in one case. The operative mortality was 26.4% (14/53); major causes of operative death were due to liver failure (six cases) and recurrent bleeding (five cases). The operative mortality was 10% in Child's Class A, 37.5% in Class B, and 73% in Class C (p < 0.05 by Fisher's exact test). The operative mortality was 18.5% in the elective group and 40% in the emergent group, but the difference was not statistically significant. The absolute overall five-year survival rate was 61.1%, but the expected 10-year survival was only 46.4%. The major causes of death during long-term follow-up were liver failure (nine cases) and recurrent bleeding (seven cases). The incidence of recurrent bleeding of esophageal varices was 44.4% in long-term follow-up. Two patients developed hepatocellular carcinoma 22 and 37 months after their operations; this incidence was much lower than that of our previous report.(ABSTRACT TRUNCATED AT 250 WORDS)