Restoration of the thoracic esophagus with aortic homograft following palliative subtotal esophagectomy

Abstract

A case of esophageal carcinoma treated by palliative resection and replacement of the portion of the thoracic esophagus with an arterial homograft is presented. This method of esophageal resection presents an easy and reasonable palliative procedure. Preserved human aortic segments give an adequate lumen, and early sealing at the anastomotic sites is believed to occur. The use of gastrostomy feedings in the immediate postoperative period is advantageous in alimenting the patient for a period while fibrotic healing of the anastomoses is occurring. Since there is a natural tendency for stenosis to occur at the suture lines, normal swallowing should be resumed as soon as a reasonable time has elapsed for sealing of the anastomoses. A careful single layer anastomosis allows for minimal concentric narrowing of the esophageal lumen. An effort should be made even in palliative resection to resect beyond areas of intramural carcinomatous extension. Further clinical use of aortic homografts for esophageal replacement after palliative resection seems worthwhile.