EXPERIMENTAL AND CLINICAL STUDIES ON THE ESOPHAGEAL STRIPPING WITHOUT THORACOTOMY OF THE ESOPHAGEAL CANCER 3. APPLICATION OF TRANSHIATAL ESOPHAGEAL STRIPPING FOR THE AGED WITH MIDTHORACIC (IM) ESOPHAGEAL CANCER

• Published in: Japanese Journal of National Medical Services Vol. 45; no. 5; pp. 461 - 467
• Main Authors: WATANABE, Akira, KAMASAKO, Akira, KOHDA, Hiroyuki, MATSUMOTO, Takashi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 20.05.1991
• Subjects: esophageal stripping; extension of operative indication; lymph nodes dissection; midthoracic esophageal cancer of the aged
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.45.461

Esophageal stripping had been a palliative procedure originally and sufficient intra-mediastinal lymph nodes dissection had not been technically possible. However, we continued to apply this procedure to operations for intrathoracic esophageal cancer. The main problem was insufficient lymph nodes dissection due to hypotension and arrhythmia during manipulation of the tissue near the heart. When the diaphragm was incised from esophageal hiatus to sternum and fibromuscular tissues between pericardium and diaphragm was fully dissected, intra-operative hypotension did not occur even if the heart was pressed by retracter. Moreover, esophageal hiatus was widened up to 20cm in length by means of lateral traction of the hiatus by heavy thread. This provided a good view of deep mediastinal cavity by additional use of lighting devices, and intramediastinal lymph nodes dissection up to tracheal bifurcation could be done using special equipments such as long scissors, hemostats and so on. These techniques and devices made it technically feasible for middle intra-thoracic esophageal cancer to dissect intra-mediastinal lymph nodes up to 5cm. higher than the lesion and to extract the intra-thoracic esophagus invertedly without thoracotomy. Twenty-eight patients with intra-thoracic esophageal cancer underwent the esophageal stripping. The average age of the patients was 71 years old, male to female ratio was 5.3:1, the advanced cancers spreading over two segments were 10 cases (35%), and operative mortality rate was 14.2% (4/28). These results showed that this modified technique was applicable and safe for the middle thoracic esophageal cancer in the elderly who were usually considered as high risk patients.