Improvement In Surgical Treatment Of Esophageal Carcinoma

Objective:to observe three unconventional surgical treatments for esophageal carcinoma.Methods:A retrospective analysis 3 group patients inclued: 5 patients undergoing simple right thoracic approach esophagectomy and esophagogastrostomy; 7 patients undergoing transhiatal esophagectomy without thoracotomy ; 3 patients undergoing a functional side-to-side cervica esophagogastric anastomosis from January 2000 to January 2004 were performed.Results:The first group: The procedures had been successfully performed for all patients. Average time of operation was 4 hours,and all carcinoma foci were excised.No patient undertook blood transfusion during operation.No postoperative anastomotic complications and massive bleeding ,etc was seen.The second group:All patients had no hoarseness after operations. The most capacity of celiac drainage was 300ml.2 of 7 (the second case and fourth case)with cervical anastomotic leakage recovered and left hospital in the 31st,35th days after operations. One suffering dyspnea after operation recovered after tracheotomy .Another was found right pleural effusion(total capacity 900ml) and thoracentesis was performed .Others without postoperative anastomotic left hospital favourably.The third group:The procedures have been successfully performed for 3 patients.No postoperative anastomotic complications were seen.Conclusion:1.Simple right thoracic approach esophagectomy and esophagogastrostomy has own superiority.It is true in operations for the cancer in the middle and upper thirds of the esophagus,especially the tumor involving the trachea,azygos vein and aorta which is more diffcult for left thoracic approach.It is ideal treatment means in the elder and those with poor heart and pulmonary function.2.esophagectomy without thoracotomy through simultaneous abdominal and cervical incisions avoid thoracotomy and reduce postoperative pain and pulmonary complications.The cervical anastomotic leakage is not more severe than those with an intrathoracic one.It is better than other operations for removing the esophagus to patients of early stage esophageal carcinoma,especially, with heart and pulmonary disease can not tolerate thoracotomy . 3.The side-to-side stapled cervica esophagogastric anastomosis is convenient to perform,and postoperative anastomotic complications may be prevented effectively.