Surgical therapy of advanced esophageal cancer. A critical appraisal.

Thirty-five patients with advanced esophageal carcinoma underwent esophagogastrectomy. Of these, 13 patients underwent esophagogastrectomy through midline celiotomy and right thoracotomy incisions (Group 1), and 20 patients underwent extrathoracic esophagectomy with either reversed gastric tube (Group 2) or isoperistaltic tube reconstruction (Group 3). Morbidity was significantly greater in patients who underwent extrathoracic esophagectomy due to more severe pulmonary complications and anastomotic fistulas. Because of these complications, a longer interval to solid food ingestion occurred in the extrathoracic esophagectomy group. Long-term survival was not affected by the operative procedure utilized. Extrathoracic esophagectomy with cervical anastomosis is associated with more complications than an intrathoracic anastomosis, resulting in inferior palliation for patients with advanced esophageal carcinoma.