Abstract
We reviewed a series of 285 patients with carcinoma of the thoracic esophagus undergoing curative resection via a right thoracotomy and laparotomy with cervical anastomosis pulling up the gastric tube by either the restrosternal or posterior mediastinal route. These 285 patients were divided into two groups: 88 patients without upper mediastinal lymphadenectomy operated on prior to 1982 (First Gr.), and 197 patients with upper mediastinal lymphadenectomy (Latter Gr.). In the First. Gr., survival was significantly better in patiens who died without tumor recurrence than in those with tumor recurrence. However, this benefit disappeared in the Latter Gr. with the increasing number of patients who died of either pneumonia, general debility, or sudden death. In the Latter Gr., body weight, vital capacity, and FEy1.0 on discharge from hospital were significantly better in 117 patients with the posterior mediastinal route than in 80 patients with the retrosternal route, as was body weight three years after discharge. A questionnaire administered to 54 patients who were alive between three and five years after the operation revealed benefits in patients with the posterior mediastinal route concerning the passage of food. abdominal pain, and shortness of breath. The posterior mediastinal route is thought to be the first choice when pulling up the esophageal substitution to the neck.
