Esophageal Surgery — Present Trends

Abstract

1. Epidermoid or squamous cell carcinoma of the esophagus is by far the predominant malignancy in this structure. An occasional adenocarcinoma of the distal esophagus occurs, but is considered by many to represent a malignancy of the upper portion of the stomach with extension to the lower esophagus. Esophageal sarcomas or leiomyosarcomas are extremely rare occurrences. 2. Twelve cases of resected epidermoid carcinoma of the esophagus are presented with a three year followup. Twenty-two cases in all were explored with nine patients having unresectable lesions at the time of thoracotomy. No statistical significance is attached to this short followup. 3. Resection of the entire esophagus from the thoracic inlet to the cardia can be accomplished through a left thoracotomy with gastric mobilization down to the pylorus, careful preservation of the gastroepiploic vessels, and sacrifice of the left gastric artery. If for some reason there is not adequate gastric length for mobilization into the chest then right colon substitution is used with preservation of the middle colic vessels. The value of gastric replacement following esophageal resection lies in the fact that one procedure only is preformed. The combined thoraco-abdominal incisions or thoracic and separate abdominal incisions extend the morbidity and the mortality. 4. Emphasis is placed on early diagnosis, and dysphagia must be thoroughly investigated by means of esophagoscopy and/or barium swallow. 5. At the present time, resection of esophageal carcinomas without evidence of distant or local metastases carries a 20 per cent cure rate. However, late diagnosis is responsible for an overall cure rate of less than 5 per cent.