Esophageal Resection and Replacement for Carcinoma

Abstract

This report covers a review of 77 cases of esophagectomy performed in the Medical University and Roper Hospitals from January 1964 through December 1975. Seventy-two cases had primary carcinoma of the esophagus. The other five had carcinoma primary in the stomach, and had proximal gastrectomy also. All except 9 cases had preoperative x-ray therapy. There were 31 white males, 13 white females, 25 black males, and six black females. Ages ranged from 37 to 73 years of age. Four methods of restoration of continuity of the alimentary canal were used. End-to-end anastomosis was use in one case. The stomach was transplanted into the thorax, and when necessary into the neck in 36; a segment of jejunum was transplanted in 12; and a segment of colon in 28 cases. Deaths and complications are reviewed. Among the 72 cases of carcinoma of the esophagus, 35 had palliative resection, 34 had theoretically curative resection and three were in doubt. There were no two year survivors among the patients having the carcinoma primary in the stomach. Among cases having the carcinoma primary in the esophagus, there have been nine cases with two year survival (12%) and six cases with five year survival (8%). On the basis of our experience, we prefer a single stage operation of laparotomy and right thoracotomy, and the use of the whole stomach placed in the esophageal bed and transplanted into the neck if necessary, except in those cases in whom there has been a previous gastric resection. Generally speaking we have had least trouble with the stomach, more with the colon, and most with the jejunum.