This article concerns with the diagnosis and treatment of 403 cases of carcinoma of the esophagus. Various factors which may contribute to improve its results, especially on those located at the upper and middle thoracic esophagus have been discussed.
1) 319 of 403 cases of carcinoma of the esophagus have been resected, the percentrge of resection is 79. 2%. However, radical resection with less possibility to leave carcinoma behind was about 34%.
2) 30% of those with chief complaints of dysphagia and feeling of stenosis at admission to the hospital had radical resection, whereas 80% of the cases with forein body feeling or unpleasant feeling of the esophagus could be resected. Therefore, the primary symptoms relating to esophagus have a significant meaning to operation.
3) A careful x-ray examination of the esophagus has an important diagnostic value. In combination with esophagoscopy and cytological study, the diagnosis of carcinoma of the esophagus is almost definitely made. However, exploratory thoracotomy is sometimes required. Carcinoma of the esophagus should be differentiated from carcinoma of the thyroid gland, mediastinal tumor, metastasis of pulmonary carcinoma to the mediastinum, right-sided thoracic aorta, pulmonary lymphadenopathy, achalasia etc.
4) Indication for operation was decided by considering the general status of the patient and local findings of the lesion. Severe anemia, dehydration and hypoproteinemia should be corrected before operation in a short period of time. The operation was contraindicated in those with low voltage, less than 0.3m V, by the ECG, severe conduction disturbance, and separated lung vital capacity less than 800 cc on the unoperated side. The operative results on those with esophageal tumor more than 6cm on the X-ray film, and situated above the aortic arch were very bad. The degree of tumor infiltration to the surrounding tissues is determined by mediastinal venography.
5) Most of the cases were operated by intrathoracic esophagogastrostomy through the right thoraco-abdominal approach. Ante-thoracic esophago-gastrostomy, esohagocolostomy, partial resetion of the esophagus replaced with transplantation of a pedicle jejunum, and alloplasty were also used. Noticeably, postoperative complaints relating to reflux esophagitis were completely eliminated in those with jejunal graft and the nutritional status has greatly improved. Antethoracic esophageal anastomosis were performed on those who may have the possibility of local recurrence. In those cases with transplantion of alloplastic, it was important to cover it over with mediastioal pleura.
6) 29 of 119 cases of the upper and middle esophagus (24. 3%) died in the immediate period after operation. 40% of the cause of death was due to pulmonary complications, which was followed with dehiscence of the anastomosis, and myocardial lesions. Lung complications were mostly noticed in the old age group with tracheobronchial diseases before operation. Pre-and postoperative management has been described.
7) According to the follow-up study two cases with operation on the upper and middle esophagus survived more than 5 years, and 8 cases with operation on the lower esophagus and cardia. The survival rate was 8%. The reason for this high mortality is due to operative cases with advanced lesions with early recurrence. If operation is performed in the early stage, the result will undoubtedly be improved.
8) The operative specimens in 82 cases of carcinoma of esophagus have been studied to investigate the individual resistance to carcinoma. In conclusion, when the interstitial tissue reaction is severe, long term survival may be possible.

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Grateful acknowledgment is made to Prof. S. Katsura and Prof. K. Nakayama for their remarkable achievement in surgical treatment of esophageal cancer.
In the discussion of surgical treatment of esophageal cancer, it should be emyhasized the importance of prevention of the early postoperative complication, especially pulmanary complication, leakage and circulatory disturbance.
We have found the use of tracheostomy without any delay as well as inhalation of 5% Carbon Dioxide with O₂ is effective in the prevention of pulmonary complication.
The incidence of leakage is very high among the ante-thoracic esophago-gastrostomy cases compared with the intra-thoracic anastomosis cases.
As prophylactic measures, we are satisfied with meticulous anastomosis technique, sufficient O₂ administration, early active nourishment by food pump and administration of anabolic steroids hormone.
To avoid the postopertive circulatory disturbances, the frequent E.C.G. examination, radiocardiographic check-up as well as balanced electrolytes should be carried out.

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Assuming the lung as being of compliance, we obtained a formula from intercavernous pressure curves recorded by the use of a special apparatus and therby produced curves representing the quantity of air which is drawn in and expelled from the cavity by respiration. At the same time we recorded intracavernous sounds caused by respiration (continuous and intermittent sounds).
An analysis of the intracavernous sound and expired air curves revealed the type and functional characters of the draining bronchus. There were quite a few cases in which respiration brought about time-to-time changes in the form and volume of the cavity. Information was obtained regarding the functional activity of the draining bronchus corresponding to these changes.

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This study as undertaken for the purpose of establishing experimentally the morphological and functional relationship between the pulmonary cavity and the draining bronchus under conditions approximate to those under which the normal physiological functions of the lung are performed. In the first place, an experimental cavity was produced in the lung of dogs and the pulmonary cavity was observed by bronchography. In the second place, observation was made on unsaturated polyester resin cast specimens of the draining bronchuchus and pulmonary cavity. As compared ith bronchography, the use of the resin cast specimens established the clear-cut and detailed relationship between the cavity and the draining bronchus. Also, the phases of connection between the cavity and draining bronchus were considerably complicated and were closely related to the conditions of the cavity. These phases fell into about five categories.

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