Oesophagectomy without thoracotomy. Experiences from 30 cases

In 26 patients with malignancies of the oesophagus or cardia and three with benign lesions the intrathoracic oesophagus was resected via abdominal and cervical incisions only and reconstructed with the stomach, a colon interposition or jejunal loop. The operation was chosen to omit the thoracotomy in patients with reduced tolerance to surgery or to secure a safe resectional margin in patients with easily resected tumours. With the exception of two patients, the method was not used for removal of mid-oesophageal tumours. Awareness of the possibility of intrathoracic complications such as bleeding into the pleural cavity is required during the procedure. A high mortality among the older patients contributed to a total mortality of 24%, indicating that the avoidance of a thoracotomy does not necessarily make the operation better tolerated, but it takes less time and postoperative morbidity is reduced.