During the period between 1971 and 1974, 25 cases of carcinoma of the hypopharynx and cervical esophagus underwent esophageal extraction and total esophageal reconstruction without operative mortality. The operative methods used for this series were blunt dissection, or everting stripping of the thoracic esophagus without thoractomy followed by pharyngogastro or -colostomy as a one stage procedure via a posterior mediastinal route created by esophageal extraction. The operative technique of esophageal extraction without thoracotomy is described. It is obvious that mediastinal tunnel is the shortest route through which to put the chosen organ for esophageal substitution. This operation is to be recommended for lesion of the hypopharynx and cervical esophagus as well as some esophageal stricture because of its operative simplicity, ease, safety and rare postoperative complications.
The technique and results of oesophageal resection through a right thoracotomy and laparotomy with reconstruction utilizing the stomach via a retrosternal route are reported. Forty patients underwent this procedure, with no mortality. The average blood loss during operation was 424 ml, and 72% of this series underwent the operation without blood transfusion. It is believed that this type of one-stage operation for carcinoma of the oesophagus is reasonable from the viewpoint of adequate resection of malignancies, and it can be performed with minimal surgical risk. With experience, perhaps it will become a standard method such as the Billroth I method in gastric surgery.
Surgical reconstructive methods after resection of the esophagus varies according to the location of the lesion. For lesions of the esophagocardiac junction, intrathoracic esophagogastrostomy through a left thoracotomy with transdiaphragmatic laparotomy has been done, but recently reconstruction by Roux-Y esophagojejunostomy or segmental jejunal interposition between esophagus and duodenum have been preferred. For lesions of the thoracic esophagus, esophagectomy through a right thoracotomy followed by laparotomy is our routine approach. The reconstructive method is cervical esophagogastrostomy by bringing up the stomach through a retrosternal tunnel.For lesions of the cervical esophagus, an effort should be made to preserve the larynx.The routine procedure consists of extraction of the thoracic esophagus, bringing up the stomach through the posterior mediastinal tunnel followed by cervical esophagogastrostomy. For advanced lesions of the hypopharynx, extraction of the esophagus is combined with pharyngolaryngectomy and permanent tracheostomy. Reconstruction is effected by pharyngogastrostomy.The extraction of the esophagus is performed by blunt finger dissection, eversion stripping with a vein stripper, or dissection with ring dissector.All these esophageal reconstructive procedures have been performed with small surgical risks (operative mortality rate 2/107, 1.9%).
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