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Introduction: We evaluated the changes in Denmark since the 1980s in the incidence, management and outcome of oesophageal resections., Material and Methods: The national patient hospital register and discharge information from the hospitals were examined for the number of oesophageal resections performed, the length of the postoperative stay, readmission, postoperative complications, and hospital mortality in the period 1/1-1997 to 30/6-2000., Results: Twenty-six departments in 18 hospitals performed 476 resections. Five hospitals accounted for 92% of all the resections performed. In three hospitals, the resections were carried out in three different departments and 18 departments performed fewer than four resections per year. The postoperative stay was 19.2 days. The frequency of surgical complications was 19% and hospital mortality was 10.7%., Discussion: The small number of oesophageal resections performed in many departments in Denmark is not in accordance with international recommendations, which say that the operation should be performed in high volume centres by experienced oesophageal surgeons, including thoracic surgeons, surgical gastroenterologists, and thoracic anaesthesiologists. On these results, it is recommended that the operation is performed in few centres and by few surgeons in multidisciplinary teams.

In order to study non-cardiac thoracic surgery in children we reviewed the files of all children under 16 years, who had surgery at the Department of Thoracic and Cardiovascular Surgery, Odense University Hospital from 1987 to 1996. Thirty-three children had chest tube insertion because of neonatal pneumothorax. Twelve of these died within five days after birth. Fifty-five children had surgery for primary intrathoracic diseases. Congenital pulmonary malformations were most common in the youngest children. Traumatic diseases were most common in the oldest. No immediate postoperative deaths occurred, but seven children were dead at the follow-up. Thirty-eight had surgery for involvement of the thoracic organs secondary to other often malignant diseases. Eleven of these were dead at the follow-up. It is concluded, that thoracic surgery is required for a number of diseases in children and is well tolerated. However, severe primary diseases lead to an increased mortality.

The purpose of the present study was to evaluate the results following surgical resection for cancer of the gastro-oesophageal junction. From 1. january 1988 to 1. april 1996 radical resection was intended in 107 patients at the Department of Thoracic and Cardiovascular Surgery at Odense University Hospital. Resection was possible in 75 patients. The operative mortality was 6.7% insufficiency of the gastro-oesophageal anastomosis was found in 6.7%. Five year survival was 24.1%. However in 52 patients where the resection was found to be radical the five-year survival was 35.3%. The results show that oesophago-gastrectomy could be performed with low mortality and morbidity. Long term survival is still low. To improve the results efforts should be directed toward earlier diagnosis, better selection and minimising post-operative complications.

The study presents our experience with video-assisted thoracoscopy and video-assisted thoracoscopic surgery (VATS) at the Dept. of Thoracic and Cardiovascular Surgery at Odense University Hospital. All VATS-procedures performed in the period 1/1 1993-30/9 1994 were prospectively registered. Sixty-seven procedures were undertaken on 63 patients with a median age of 35 years (range, 13-75 years). Twenty diagnostic and 47 combined diagnostic and therapeutic procedures were performed. The indications were spontaneous pneumothorax, pleural changes, diffuse interstitial lung disease, Raynaud's disease, localized lung lesion, and abnormal chest X-ray in patients with previous extrathoracic malignancy. In patients with pneumothorax, the most frequent procedures were pleurodesis with fibrin glue sealant, wedge resection with endostapler, and pleural abrasion. In the remaining groups, the most frequent procedures were pleural biopsy, wedge resection of lung parenchyma, and thoracic sympathectomy. The median time consumption during the surgical part of the VATS-procedures was 50 minutes (15-130 min.), and median hospitalization time after VATS was three days (1-10). Drains were left for more than two days after 13 procedures (22%), most often due to air leakage or persisting pneumothorax. Four VATS-procedures were converted to thoracotomy, and three had thoracotomy at a later stage during hospitalization. All thoracotomies were related to preexisting disease. No major procedure-related complications occurred. A diagnosis was achieved in every case where VATS was aimed at being purely diagnostic. Two patients had sympathectomy with good results. We conclude that VATS seems of advantage for diagnosis and therapy in many cases of benign intrathoracic disease. In addition, a histological diagnosis can be achieved and operability assessed in many cases of intrathoracic malignancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Due to the latest advances in video technology and endoscopic instruments, thoracoscopy has changed from being mainly diagnostic to include many threapeutic procedures in the thorax. The article reviews equipment and techniques as well as attempts to reflect current attitudes to indications for their use.

In a retrospective investigation, 17 Danish Departments of Surgery reported on morbidity and mortality following surgical treatment of cancer of the oesophagus and cardia in the years 1985-1988. The study comprised 352 men and 112 women, representing 98% of the total number of resections performed in Departments of General Surgery (11%), Departments of Surgical Gastroenterology (24%) and Departments of Thoracic Surgery (65%). Nine departments performed less than five resections per year. Frequency of anastomotic leaks were 8.2%, and the mean hospital mortality was 16.6%. Mortality was significantly lower (median 9.6% and 7.0%) in departments performing more than 20 resections per year. It is concluded that in Denmark, surgical treatment of cancer of the oesophagus or cardia should be centralized to departments performing more than 20 resections per year.

Ambulatory simultaneous recording of oesophageal pressures and pH is a recently developed technique for evaluation of oesophageal function. The paper describes the experience gained with this technique at the Oesophagus Laboratory, department of Thoracic and Cardiovascular Surgery T, Odense University Hospital. A combined pH and pressure probe is positioned in the oesophagus and connected to a portable recorder. Data are digitised on-line and stored for later transfer to a computer. Analysis of pH-variations and contractile activity is performed automatically. Sections with normal and abnormal acid clearing are shown. A normal pressure response to reflux consists of frequent contractions of normal amplitude and propagation resulting in a stepwise clearing of acid from the oesophagus. Repetitive simultaneous contractions and periods of failed peristalsis are illustrated in sections from a patient with oesophagitis. Contractions of high amplitude and prolonged duration, as well as frequent non-propagating contractions in the distal oesophagus, are elements of a normal peristaltic pattern. The conventional manometric investigation performed under laboratory conditions still has first priority when esophageal dysmotility is suspected. In several instances, however, ambulatory recording of motility and pH may add valuable additional information.

A case of asymptomatic benign mediastinal teratoma is presented. The necessity for definite diagnosis of mediastinal tumours is stressed together with the need for conferences involving several specialties.