Optimal Method of Replacement of the Esophagus in Cancer
The first subject discussed was the management of cervical and especially high cervical carcinoma. The operability of these lesions was estimated at 20%–25% and therefore seems rather low in various series. The experts felt that the operation should start at the neck, exploring operability both in terms of extension of the tumor and involvement of the nerves. When operable, the stomach should be mobilized and pulled up through a complete sternal split, resecting the esophagus up to the cricopharyngeal muscle and, in certain instances, even up to the pharynx proper. It was stressed that functional disturbances are more likely to occur the higher the anastomosis is placed. The operation should be done in one stage, and the stomach be placed behind the sternum rather than subcutaneously. However, when there is any question of tumor remaining in the neck, the stomach might preferable be placed subcutaneously, to avoid strangulation by the tumor at the thoracic outlet. Furthermore, it was stressed that the pulled-up organ should not be put into the bed of the esophagus, in case irradiation was to follow. Both stomach and colon seem to react unfavorably to postoperative in irradiation.
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