EXPERIENCES WITH THE COLLAR AND THORACAL ANASTOMOSES AFTER SUBTOTAL ESOPHAGECTOMY REGARDING SAFETY AND COMPLICATION RATE

In the period from 1988-1992 we performed 148 subtotal esophagectomies . In 69 % (102 cases) the operation was carried out because of squamou s cell carcinomas of the esophagus, in 27 % (40 cases) because of aden ocarcinomas and in 4 % (6 cases) because of other indications. In 97 % (143 cases) the passage was reconstructed by means of a tubulised gas tric pull-up established by Akiyama and in 3 % (5 cases) by means of a colon interposition, whereby all interponates were pulled up through the posterior mediastinum. The esophago-gastrointestinal anastomosis w as performed in 98 % (145 cases) by a hand made suture end-to-side. In 2 % (3 cases) we performed the anastomosis by a mechanical EEA device . The collar anastomoses (n=88) on the posterior wall were covered wit h the remainder of the gastric fundus, the thoracal anastomoses (n=60) on the anterior wall were secured by means of a plication. Postoperat ive surgical complications occurred in 22,7 % of the collar and in 25, 0 % of the thoracal anastomoses. Insufficiencies (n=3) were observed w ith thoracic anastomoses only. 2 of the 3 insufficiencies were lethal. Postoperative paralysis of the n. recurrens, disturbance of swallowin g coordination and aspiration occurred in 29,5 % of the collar and in 13,4 % of the thoracal anastomoses. In contrast to other reports we we re able to show that the collar esophago-enteroanastomosis after subto tal esophagectomy is safer than the thoracic anastomoses with regard t o anastomotic insufficiencies. However, collar anastomoses have a high er rate of postoperative functional disturbances, although these compl ications can be brought under control with the appropriate management. For this reason we prefer the collar anastomoses in all cases of intr athoracic esophagus carcinoma, and restrict the abdomino-thoracic proc edure to cases of abdominal esophagus carcinoma only.