Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus.

Between 1 October 1979 and 1 September 1983, 34 patients with 25 adenocarcinomas and nine squamous cell carcinomas of the cardia and lower part of the esophagus have been treated with resection of the celiac lymph nodes (metastasis in 83 per cent of the patients), the lesser curvature of the stomach, cardia and total esophagus without thoracotomy. There was transmural spread of the cancer in 88 per cent of the patients. The esophagus was replaced by a tube made from the greater curvature of the stomach, which was brought through the mediastinum and anastomosed to the cervical esophagus. There was a hospital mortality of 2.9 per cent and the median hospital stay was 15 days. Morbidity included seven anastomotic leaks which closed spontaneously, intrathoracic bleeding (one), secretion retention (six), transient hoarseness (12), persistent dysphagia (one) and transient dumping syndrome (four). No patient has complained of aspiration or reflux of gastric juices. Satisfactory long term relief of dysphagia was achieved in 94 per cent of the patients. There have been no recurrences of tumor at the site of the anastomosis. The one year survival rate is 70 per cent and the median survival time is 19 months.