[Experience on resection of carcinoma of the esophagus and gastric cardia in consecutive 709 cases without anastomotic leaking and operative mortality].

From April 1983 to September 1992, we performed surgical treatment for 751 consecutive cases of carcinoma of the esophagus and gastric cardia. 709 patients had complete resection. Among them 314 were carcinoma of the esophagus, the rest were of the gastric cardia. The total resectability was 94.4%. In 55 cases the carcinoma of the esophagus was excised from the left thorax. 185 cases had an excision of Ivor-Lewis esophagogastrectomy. In 52 cases it was excised through right thorax, the left neck and the upper abdomen. The carcinoma of gastric cardia was excised from left thorax in 254 cases, from abdomen in 141 cases. Among 709 cases, there were 73 cases with complications including that in the lungs in 26 cases (35.6%). There was no death within 30 days or during the stay in hospital after the operation. The authors hold that the key to reduce operative mortality is to prevent anastomotic leaking. Proper operative approaches should be chosen carefully according to the different position of the pathologic changes so as to gain a thorough operative exposure. The technique of anastomosis is of the key importance. The anastomosis with extending the esophageal mucosa may prevent leaking effectively. Besides, it is necessary to effectively deal with post-operative complications in time, especially when there is a massive bleeding while carrying on drainage in the thoracic cavity during the early postoperative-stage. Bleeding should be staunched in time inside the thorax again.