Abstract
For the resection of cervico-thoracic esophageal cancer, we prefer a local excision with free jejunal reconstruction to a total esophagectomy with gastric pull-up, considering the postoperative quality of life. However, we encountered a patient in whom it was difficult to select the surgical procedure due to three problems: 1) The patient's body mass index was as low as 18. Thus, gastric pull-up, which is likely to cause further weight loss, was not encouraging. 2) The patient had undergone an excision of the left half of the sternum plus left ribs of the first and below during the previous surgery for recurrent breast cancer. Therefore, further intervention to the sternum was contraindicated. 3) Excision of the thoracic esophagus to the level of the aortic arch seemed to be essential. After discussion with gastroenterological surgeons, the operation was conducted under the following plan: Try local excision first, and if a safe excision as well as a free jejunal reconstruction is not feasible, perform a total esophagectomy with gastric pull-up as a secondary treatment. The esophagus was circumferentially dissected in the mediastinum and was pulled upward until a safe excision and reconstruction of the thoracic esophagus could be achieved. As s consequence, we successfully accomplished a larynx-preserving cervico-thoracic esophagectomy without any intervention to the sternum. The postoperative course was uneventful and the patient's body weight remains stable one year after surgery. We herein describe the technique and critical points of the surgery.
