16 Cases Report about Stomach Substitute Esophagus via Substernal Route after Resecting Esophageal Carcinoma by "Three Incision" Approach
Chen Qixun; Yan Fulai; Mao Weimin, et al. (Zhejiang Cancer Hospital, Hangzhou 310022)
(Purpose) To appraise the pratical value of surgied managment for midddle third esophageal carcinomas: after resection of the carrinoma by right cbest, neck and upper abdominal "three indsions", pulling up stomach substemally to anastomose with the residual neck esophagus, (Methods) 16 cases of middle third esophageal carcinomas of which the lesions were more than 5cm in length treated surgically as following: right thoracotomy for dissection of the carcinoma and regional lymph nodes. Laparotomy to mobilize the stomach and dissect the paragastric lymph nodes, then pulling the stomach up through the subsernal canal to anastomose with the residual esophagus in the neck. Lower neck lymph node dissection was done afterward. (Results) Among the 16 cases, 10 were resected radically, and the others wer resected palliatively- Anastomotic leak occurred in 37. 5%, but all the leakages were cured by prope drainage No cardic and pulmonary complication occurred. (Conclusions) "Three incision" approah for resection of midddle third esophageal carcinomas aocords with the therapeutic principle of oncological surgery, and the substernal route by which the stomach is pulled up to anastomose with the residual esophagus in the neck is feasible. This procedure can be applied for advanced middle third esophageal carcinoma for which adjuvant radiotherapy probahly be used postoperatively.