Abstract
A 61-year-old man who received close exploration for unpleasant sensation of the throat was diagnosed as cancer of the upper thoracic esophagus. He underwent thoracoscopic subtotal esophagectomy with three field lymph node and cervical esophagogastric anastomosis via the retrosternal route using a small diameter gatric tube of laparoscopic creation. A CT scan and upper GI fluoroscopic study were performed for postoperative dysphagia disclosed that oppression with the manubrium sterni might cause gastric tube constriction. Accordingly, we performed partial sternal resection that resulted in an improvement of passage disturbance. The retrosternal route is superior to the intrathoracic route in terms of a low risk of causing mediastinitis when anastomotic leakage occurs and an easy approaching if metachronous cancer occurs in the pulled-up stomach. However, if an entrance portion of the thorax is small and/or narrow, passage disturbance or compression with necrosis of the reconstructed organ can occur, where we need to change the pulling-up route of the gastric tube or to consider surgical resection of the sternoclavicular joint. We present a case of gastric tube constriction which was successfully resolved by partial sternal resection.
