Abdominal and right thoracotomy approach as standard procedure for esophagogastrectomy with low morbidity

A series of recent articles advocate that blunt esophagectomy through neck and abdominal incisions has superior perioperative results to esophagogastrectomy via thoracotomy and abdominal approach. This prompted a review of a personal series of 40 consecutive esophagogastrectomies performed between July 1978 and December 1985. Diseases included squamous cell cancer in 15 patients, adenocarcinoma in 22, Barrett's esophagus with cancer in two, and fibromyomatoses in one. The approach was en bloc resection through an abdominal incision and right thoracotomy; a cervical incision and anastomosis was added for proximal lesions. All anastomoses were hand-sewn interrupted suture technique. Perioperative results were superior to those reported for blunt esophagectomy. Mortality was zero, no anastomotic leaks occurred, and no major pulmonary complications were seen. Four of the 40 patients required blood transfusions that totaled 8 units. Average preoperative hematocrit value was 38.9% +/- 5.44% (standard deviation) and postoperative hematocrit value was 35.57% +/- 6.06% (standard deviation). Average operating time was three hours and 26 minutes +/- 41.43 minutes and hospital stay was 11.1 +/- 4.62 days (standard deviation). Three patients required transient anastomotic dilations. It is concluded that esophagogastric en bloc resection which uses an abdominal and right thoracic approach can be accomplished with a low morbidity and mortality. A limited thoracic incision, double-lumen endotracheal tube, and self-retaining retraction on the lung minimized pulmonary trauma and respiratory problems were not a factor.