The Annals of Thoracic Surgery, Vol 27, 399-403, Copyright © 1979 by The Society of Thoracic Surgeons
Pull-through esophagectomy without thoracotomy for esophageal carcinoma
S Szentpetery, T Wolfgang and RR Lower
Seventeen consecutive patients underwent pull-through esophagectomy using
blunt dissection from laparotomy and cervical incisions for carcinoma of
the esophagus. Fifteen patients had a middle-third lesion while 2 patients
had a distal-third lesion. The gastrointestinal tract was reconstructed
using primary gastroesophagostomy in 15 patients and colon interposition in
2. Both the colon and stomach were placed through the posterior
mediastinum. The surgical technique and results are described in detail.
There were two major complications. One patient died of massive gastric
hemorrhage on the eighth postoperative day in spite of emergency operation.
Another patient sustained a tear of the membranous trachea at the time of
blunt dissection. This was repaired through a right thoracotomy without
difficulty. Esophagectomy using blunt dissection offered excellent
palliation and resulted in little morbidity in our series. The shortened
operating time, minimal blood loss, total lack of postoperative chest pain,
minimal pulmonary complications, and the benefit of a cervical anastomosis
are several advantages compared with the present surgical approaches.
