Oesophagectomy with and without thoracotomy for carcinoma of oesophagus

ABSTRACT

Between January 1988 and Decemberi 1989, 70 patients with carcinoma of oesophagus were seen in the Department of Surgery [Thoracic Clinic]. Of these 70 patients, 30 had unresectable tumours and received radiotherapy. Remaining 40 patients were selected for surgery. A combination of radiotherapy and surgery was used in 6 patients and in 5 chemotherapy was added. The majority [75%] had squamous cell carcinoma and other [25%] had adenocarcinoma. 50 percent had lower oesophageal lesion, 25% had middle lesions, 12.5% had upper oesophageal lesions and 12.5% had lesions involving the cardia. Stage I was assessed in 7.5%, stage II in 15%, stage III in 27.5% and stage IV in 50%. Blunt oesophagectomy without thoracotomy was performed in 15 patients with carcinoma involving various levels of the oesophagus [5 cervicothoracic, 6 middle third and 4 distal third including cardia]. Oesophageal resection and reconstruction was performed in a single stage. The continuity of alimentary tract was restored by anastomosing cervical oesophagus to the stomach, which was positioned in the posterior mediastinum, in the original oesophageal bed. There were no deaths directly related to the technique of blunt oesophagectomy. Average intraoperative blood loss was 1250ml. Complications in these patients included pneumothorax [4], transient hoarseness [2], pleural effusion [2], anastomostic leak [2] and subphrenic abscess [1]. The 3 deaths were due to pneumonia [2] and pulmonary embolism [1]. In the remaining 25 patients, standard oesophagectomy with a thoracotomy was performed. A comparison of the results obtained with these two techniques of oesophagectomy was made. It was found that blunt oesophagectomy is safe and is far better tolerated physiologically than the combined transthoracic and abdominal operations