Endoesophageal pull through. A technique for the treatment of cancers of the cardia and lower esophagus
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Transthoracic and extrathoracic approaches to cancers of the lower esophagus and cardia each have advantages and drawbacks; the trauma of thoracotomy must be balanced against that of blunt mediastinal extraction of the esophagus. A different surgical approach is proposed in this paper, avoiding both thoracotomy and encroachment upon thoracic mediastinal structures. This technique is based on the removal of the tumor and the esophageal mucosa above it as a distinct anatomic layer by blunt dissection through separate abdominal and neck incisions. This is followed by pulling upward a segment of stomach (or colon) through the esophageal muscular tunnel into the neck for a cervical anastomosis. This endoesophageal pull through (EEPT) approach has been used in the surgical treatment of a total of ten patients, six with adenocarcinomas of the cardia and four with squamous cell carcinomas of the lower esophagus. In nine patients the stomach, and in one patient the left colon, was brought to the neck to reestablish gastrointestinal (GI) continuity. The operation was well tolerated. There was no excessive intraoperative or postoperative bleeding, and there was no in-hospital mortality up to 30 days. The major postoperative complication was cervical anastomotic leakage seen in four patients. The EEPT technique is a palliative approach for cancers of the lower esophagus and cardia, comparing favorably with the standard extrathoracic or transthoracic transhiatal procedures.