Functions of the stomach placed in the posterior mediastinum after esophagectomy were studied in 20 esophageal carcinoma patients. Seven were long-term survivors who lived more than 5 years after operation, and five of them showed normal fasting serum gastrin levels and good or fair gastric acid secretion. Of 13 patients who had their operations within 3 years before the study, 11 showed high fasting serum gastrin levels and poor gastric acid secretion. The hepatobiliary and alimentary scintigrams with double isotopes demonstrated a time lag between the excretion of the food from the stomach and the excretion of bile into the bowels, regardless of the postoperative periods. Absorption of vitamin B12 was normal in patients who lived more than 2 years after operation. The intraluminal pressure and pH studies in long-term survivors showed that our operative technique, the posterior invagination esophagogastrostomy, was effective in preventing a gastroesophageal reflux in the anastomosis.
From October 1967 to August 1976 posterior invagination esophagogastrostomy in 1 stage without positional change was performed on 84 patients. Since 1971 this method has been extended to include 32 cases of cancer of the upper and middle thirds of the thoracic esophagus. The anastomosis was constructed in the neck in 27 patients, and in the thoracic cavity in 5 patients (1 supra-aortic, 2 at the level of the aortic arch, and 2 at the level of the inferior margin of the aortic arch). There were no instances of postoperative anastomotic leakage, hemothorax, chylothorax or pyothorax. Six of these patients (18.8%) died of circulatory insufficiency or pulmonary complications within 1 month of operation. Postoperative esophageal stenosis occurred at the site of anastomosis in 4 patients and was relieved by bougienage dilatation or operation under local anesthesia. Of the 32 patients with lesions in the upper and middle thoracic esophagus, 17 survived for 6 months after operation, 6 have lived for at least 3 years, and 4 are still alive after 4 years. Postoperative examinations of autonomic nervous system and cardiopulmonary functions revealed no abnormalities. In the early postoperative period, lipid and Vitamin B12 absorption was markedly disturbed but returned to normal levels by the time of the follow-up studies.Esophageal surgery originated in 1886 when Mikulicz reconstructed the cervical esophagus with a skin flap after resection of an esophageal cancer. In 1913 Torek [1] reported the first successful resection of the thoracic esophagus for carcinoma. Since then,
Three Japanese patients with von Recklinghausen's disease and malignant changes were studied. The primary lesions of malignant changes were the chest wall in Case 1, the buttock in Case 2, and the neck in Case 3. After excision of the tumors, there were local recurrences in Cases 1 and 2. Distant metastases developed during treatment in these patients. One of the patients (Case 1) died 21 months after the initial diagnosis of malignancy. Multidisciplinary treatment was of some value in suppressing local recurrences and pulmonary metastases in Case 2. Pulmonary metastases were evident at the time of admission to our hospital in Case 3. Although the primary and metastatic tumors were removed, the patient died 8 months after the initial diagnosis of malignancy. We conclude that careful follow-up should be required in patients with von Recklinghausen's disease because of the possibility of malignant changes. When there is a suspicion of malignancy, an extended en-block excision must be performed.
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