Abstract
For recent thirty years I have carried out 1, 174 resections of the esophageal cancer in the upper and middle thoracic segments. By early diagnosis and combined therapy of the pre-operative irradiation and the ante-thoracic subcutaneous esophagoplasty, divided into three stages if necessary, the operative mortality was decreased (6.0%), whereas the survival rate was increased.
For the protection of the leakage at the anastomotic site in the ante-thoracic esophagogastrostomy, some modified techniques have been devised. The greater omentum was covered to the anastomotic site and the circular cuttings of the sero-muscular layers of the stomach were performed to elongate the gastric tube.
The anastomosis was carried out in layer-to-layer suturing.
The five year survival rate was 12.3%. In 149 patients to whom the pre-operative irradiation was administered, the five year survival rate rose to 15.8%, whereas in the remaining 390 patients five year survival rate was 10.8%. At the end of the last year, 110 of my cases had survived over five years, 40 of these had lived for more than ten years, 13 for more than fifteen years and 4 for more than twenty years.
The statistical analysis of the long-term living patients revealed the following results. When the defect on the X-ray film was less than 6cm, the long-term prognosis was more favorable.
The shape of the defet on the X-ray film also affected the prognosis. The prognosis was best in cases with a saw-like shape, but it was worst in those with funnel shape. Whether the operation was radical or conservative was of greatest importance for the prognosis. When the radical resections were performed in grade III, the five year survival rate was 26.7%. Otherwise when the radical operation was performed in grade I, the five year survival rate was 2.7%.
