INTRATHORACIC ANASTOMOSIS AFTER ESOPHAGEAL RESECTION FOR CANCER

Cervical anastomosis has been advocated to avoid the pulmonary complic ations and life-threatening anastomotic disruptions following intratho racic oesophagogastric anastomosis. This is a retrospective review of 111 oesophageal resections followed by an intrathoracic anastomosis. T hese resections were performed between September 1993 and August 1994 within a residency training program. The left thoracoabdominal approac h was used for distal tumours and the Ivor Lewis technique for more pr oximal tumours. Squamous cell carcinoma accounted for 72% patients (n = 80), adenocarcinoma for 25% (n = 28), and others for 2.7% patients ( n = 3). Of the patients, 69% had pathologic Stage III tumours. Operati ve mortality rate was 1.8% (two patients). Perioperative complications occurred in 39 patients, including anastomotic leak in 10 patients an d myocardial infarction in 2 patients. In the absence of a leak, there were no major pulmonary complications requiring intensive care or ven tilatory support. Of those patients with anastomotic disruption, 80% w ere salvaged by early clinical diagnosis and appropriate treatment. We conclude that transthoracic oesophagectomy with an intrathoracic anas tomosis is a safe procedure that can be performed with low mortality a nd acceptable morbidity. (C) 1996 Wiley-Liss, Inc.