EXTENDED ESOPHAGECTOMY IN THE MANAGEMENT OF CARCINOMA OF THE UPPER THORACIC ESOPHAGUS

Upper thoracic esophageal tumors adjacent to the trachea often require a preliminary thoracotomy to accomplish resection. Between January 19 85 and July 1992, 49 consecutive patients (38 men and 11 women) underw ent extended esophagectomy for esophageal cancer where the neoplasm wa s mobilized through an initial right thoracotomy and then resected and reconstructed through an abdominocervical approach. Ages ranged from 40 to 80 years (median 63.4 years). The tumor was located in the upper third of the thoracic esophagus in 44 patients and in the middle thir d in five. Thirty-three patients had squamous cell carcinoma, 14 had a denocarcinoma, and two had adenosquamous cell carcinoma. Complications occurred in 35 patients (71.4%) and included anastomotic leak in 15, vocal cord paralysis in 11, atrial arrhythmia in nine, pneumonia in si x, wound infection in five, and postoperative bleeding in one. Three p atients required tracheostomy. There was one postoperative death (2.0% ). Median survival was 0.9 years (range 1 month to 5.1 years). Thirty- one patients were alive at the time this article was written, 28 witho ut evidence of cancer. Cause of death was recurrent disease in 13 pati ents, unrelated to cancer in three, and unknown in one. Overall actuar ial 3- and 5-year survivals were 48.6% and 18.2%, respectively. Four-y ear survival for stage II disease was 44.6% as compared to 24.9% for s tage III (p < 0.02). The presence of lymph node metastases significant ly affected survival. Three-year survival for patients with NO disease was 77.9% compared with 20.9% for patients with N1 disease (p < 0.01) . Age, sex, and cell type had no effect on survival. Ten patients had late dysphagia, four had gastroesophageal reflux, and one had dumping symptoms. Although associated with significant morbidity, we conclude that extended esophagectomy is an acceptable method of management for tumors of the upper thoracic esophagus. Mortality is low, and long-ter m results are reasonable.