Pull-through esophagectomy without thoracotomy

Twenty patients with carcinoma of the hypopharynx, esophagus and thyroid underwent pull-through esophagectomy. Seventeen of them received combined resection of the larynx and trachea. Dissection of the lymph nodes at the upper mediastinum was performed in 11 patients by sternotomy. Seven patients received mediastinal tracheostomy after combined resection of the trachea and the larynx. Pull-through esophagectomy was followed by pharyngogastrostomy without thoracotomy via the posterior mediastinum. This technique is described in detail. Because there is no thoracotomy and ligation of the esophageal vessels is ensured, no pulmonary complications and no massive mediastinal hemorrhages occurred. There were no operative deaths. This operation offers excellent palliation and little morbidity. Moreover, the use of sternotomy and mediastinal tracheostomy for pull-through esophagectomy made it possible to dissect the upper mediastinal lymph nodes, and we could resect the affected trachea with certainty.