Reconstruction of the esophagus by left transpleural transdiaphragmatic approach and cervical sophagogastrostomy with gastric tube

Abstract

From January 1971 to December 1977 left transdiaphragmatic approach and cervical esophagogastrostomy with gastric tube in one stage without surgical positional change was performed on 53 patients with esophageal cancer of the middle or lower thoracic esophagus. The esophagogastrostomy with end to side anastomosis was constructed in the left neck in 50 patients. There were no instance of postoperative anastomotic leakage or stenosis. Four of these patients died of pulmonary complications or cardiac insufficiency within one month of operation. The operation with this approach has several advantages as follows; The change of surgical posture was not necessary during the operation. The second merit is a decrease on the incidence of postoperative pulmonary complications depending upon this technic without upper median abdominal incision. Moreover, this approach has another advantage on the dissection of upper mediastinal metastatic lymph nodes such as Botallo's node. 1) 53 cases of the resectable esophageal cancer from 1971 through 1977 in our department, were treated with good prognosis. 2) Mostly, we interposed the plastic gastric tube along the retromediastinal route with few complications. 3) The esophagogastrostomy with end to end or end to side anastomosis individually, according to the general conditions of patients. 4) Early tube feeding by means of a plastic gastric tube showed the ideal physiological quality and provided well improved nutrition. 5) The good adequate blood supply of the plastic gastric tube was found not to cause the ischemic change and the necrosis of its stump. 6) The left transthoracic transdiaphragmatic operative approach diminished the postoperative stress and pulmonary complications. 7) This operation satisfied the radical dissection of lymph nodes. 8) The second operation for closure of fistula is harmless and simple. © 1979, Kurume University School of Medicine. All rights reserved.