Abstract
During the past 13 years, 86 patients with carcinoma of the esophagus situated at the superior mediastinal segment were admitted and treated at the Queen Mary Hospital, Hong Kong. Only 17 of these patients underwent resection. The resection technique was based on what was described in 1957 by Waddell and Scannell and by Cauchoix and Binet. The whole of the esophagus was removed in each case and the reconstruction, using the stomach, was accomplished by anastomosing the fundus to the cricopharyngeus. In 1 patient an isolated jejunal segment was used in the esophagoplasty, while in another the colon was utilized. There were 3 postoperative deaths, 1 due to a gastrotracheal fistula from erosion by the tracheostomy tube, a second due to hemorrhage, and a third due to bronchopneumonia. Four patients are currently alive and well without evidence of cancer. The longest survivor has lived for 5 years and 3 months. Ten of the patients who were discharged from the hospital lived for from 2 to 15 months, with an average of 8.7 months. This compares favorably with the 6.9 months average survival reported by Procter in patients with carcinoma of the upper third of the esophagus who were treated by radiotherapy. While the mortality rate is still high, the results are encouraging and continued use of surgical treatment is certainly warranted.
Résumé
Au cours des 13 dernières années, 86 malades atteints de cancer de l'oesophage médiastinal supérieur ont été admis au Queen Mary Hospital, Hong Kong. Une résection a pu être réalisée dans 17 cas seulement. La technique d'exérèse est inspirée des descriptions de Waddell et Scanneil et de Cauchoix et Binet (1957). Dans chaque cas, l'oesophage a été réséqué en totalité et remplacé par l'estomac, dont le fundus est anastomosé au crico-pharyngien. Dans 1 cas cependant, l'oesophagoplastie a été faite par transplant jéjunal, et dans 1 autre cas en utilisant le colon. Il y a eu 3 décès postopératoires: 1 fistule gastro-trachéale par érosion par le tube de trachéotomie, 1 hémorragie, et 1 bronchopneumonie. Quatre patients sont actuellement en vie sans signe de récidive cancéreuse. La plus longue survie est de 5 ans 3 mois. Dix malades ont survécu 2–15 mois, avec une moyenne de 8.7 mois. Ces résultats sont au moins aussi favorables que ceux de Procter qui a une survie moyenne de 6.9 mois pour les cancers du 1/3 supérieur de l'oesophage traités par radio-thérapie. La mortalité est certes encore élevée, mais les résultats encourageants justifient l'utilisation du traitement chirurgical.
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Ong, G.B., Lam, K.H., Lam, P.H.M. et al. Resection for carcinoma of the superior mediastinal segment of the esophagus. World J. Surg. 2, 497–503 (1978). https://doi.org/10.1007/BF01563683
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DOI: https://doi.org/10.1007/BF01563683