Esophagectomy without thoracotomy: is there a risk of intramediastinal bleeding? A study on blood supply of the esophagus.

In transhiatal blunt esophagectomy there is surprisingly little bleeding if no adjacent great vessels are torn. This prompted an investigation by new injection techniques and corrosion on the human esophageal vasculature three-dimensionally. The three main arterial sources were confirmed: the superior thyroid artery, bronchial arteries at the level of the carina, and the left gastric and splenic artery. Two facts became obvious that were not appreciated hitherto. All major vascular trees divide into minute branches at some distance from the esophagus. Those branches go on to form a dense submucosal interconnected network. It appears that such small extraesophageal branches, when torn, will have the benefit of contractile hemostasis. Previous claims made that essential nutritional vessels arise from intercostal phrenic arteries or the aorta directly could not be confirmed. These findings would confirm blunt esophagectomy for tumors within the wall of the organ as a relatively safe procedure in terms of bleeding hazards.