ESOPHAGOGASTRECTOMY WITHOUT THORACOTOMY FOR CARCINOMA OF THE CARDIA AND LOWER PART OF THE ESOPHAGUS

Abstract

Between Oct. 1 1979 and Sept. 1 1983, 34 patients with 25 adenocarcinomas and 9 squamous cell carcinomas of the cardia and lower part of the esophagus were treated with resection of the celiac lymph nodes (metastasis in 83% of the patients), the lesser curvature of the stomach, cardia and total esophagus without thoracotomy. There was transmural spread of the cancer in 88% of the patients. The esophagus was replaced by a tube made from the greater curvature of the stomach, which was brought through the mediastinum and anastomosed to the cervical esophagus. There was a hospital mortality of 2.9% and the median inhospital stay was 15 days. Morbidity included 7 anastomotic leaks which closed spontaneously, intrathoracic bleeding (1), secretional retention (6), transient hoarseness (12), persistent dysphagia (1) and transient dumping syndrome (4). No patient has complained of aspiration or reflux of gastric juices. Satisfactory long term relief of dysphagia was achieved in 94% of the patients. There were no recurrences of tumor at the site of the anastomosis. The 1 yr survival rate is 70% and the median survival time is 19 mo.