[Evaluation of the collo-thoraco-abdominal dissection for the intrathoracic esophageal carcinoma]

Five hundred and forty three cases of intrathoracic esophageal carcinoma were reviewed. Of these, one hundred and sixty one cases had collo-thoraco-abdominal (CTA) dissection and three hundred and eighty two cases had thoraco-abdominal (TA) dissection. Postoperative pulmonary complications occurred in 35.5% of the patients who had CTA dissection and in 18.0% of those who had TA dissection. Incidences of postoperative hoarseness of voice and anastomotic leakage were almost similar in the two groups. However, the mortality rates within 30 postoperative days was 4.3% for the CTA groups compared to 1.8% for the TA group. The average number of lymph nodes resected per case was much higher in the CTA group than than the TA group. This implied that the dissection was more extensively performed in the CTA group involving not only bilateral cervical regions but also the upper mediastinum continuing into the neck. Better 1, 2 and 3 years survival rates were observed in the CTA group than the TA group, but for the 4, 5 years survival rates there was no statistical difference noted. For stage-0 and stage-4 carcinoma of the upper third esophagus, marked improvement in the survival rates were obtained in the CTA dissection cases. In conclusion, collo-thoraco-abdominal dissection can be justified for the surgical treatment of intrathoracic esophageal carcinoma despite its postoperative mortality rate of 4.3%.