[Esophagectomy for advanced malpighian cancer of the thoracic esophagus. Esogastric anastomosis in the neck or in the thorax? Late results of a "randomized" prospective study].

During a 2 1/2 year period, 60 consecutive patients with cancer of the thoracic esophagus were randomized to undergo cervical (CA) or thoracic (TA) esophago-gastrostomy. The tumors were staged post-operatively and were almost equally distributed between the two groups. The esophageal specimens were macroscopically studied on the fresh specimens with vital staining, then microscopically. The prevalence of peri-tumoral mucosal and sub-mucosal lesions was confirmed. Microscopic malignant invasions of esophageal sections were more frequent in TA (10) than in CA (3). Resected positive lymph nodes were more numerous in CA (17) than in TA (7). The mortality was identical in the two groups. Respiratory complications and recurrent laryngeal nerve trauma were more frequent in CA. Long-term survivors had N0 disease with a healthy esophageal section. Even though subtotal esophagectomy reduces the prevalence of microscopic esophageal wall invasion at the upper section level and allows more complete unilateral exploration and resection of invaded lymph nodes, it offers no significant benefit concerning survival of patients with advanced cancer and malignant lymphadenopathy, after resection with post-operative radiotherapy.