One-stage surgery for esophageal cancer

Of 102 patients operated on from 1985 to 1989, 75 patients had esophageal cancer, 21 had cancer of the cardia involving the thoracic portion of the esophagus, 3 had gastroesophageal cancer, 2 had leiomyosarcoma, and 1 had an epidermoid lesion of the middle third of the esophagus and cardial adenocarcinoma. All of them underwent extirpation of the esophagus with one-stage esophagoplasty and the establishment of a cervical anastomosis. The esophagus was replaced by an isoperistaltic tube made from the greater curvature of the stomach in 95 patients, from the colon in 4, and from the small intestine in 3 patients. The abdominocervical approach was employed in 86 patients and with additional right-side thoracotomy in 16 patients. The gastric graft was formed using a laser scalpel and suture instruments. Postoperative mortality was 4.9% (i.e., 5 deaths). A number of surgical approaches through the abdomen are suggested, permitting visual exposure of the esophagus up to the aortic arch.