Operative technique for carcinoma of the oesophagus after distal subtotal gastrectomy: a new method using the residual stomach to reconstruct the alimentary tract.

The stomach is the organ most often chosen for substitution following resection of the oesophagus for carcinoma and this method has given good results. The mode of reconstruction of the alimentary tract in oesophageal cancer patients with previous distal gastrectomy presents a surgical problem. Usually the colon or jejunum is chosen as an alternative for substitution in such patients. We report a new technique used in our unit on 30 patients with previous distal subtotal gastrectomy. This involves using the residual stomach for reconstruction and transposing the spleen and tail of the pancreas into the left thoracic cavity in order to preserve the blood supply to the stomach. The entire procedure is performed through the left chest. We explored 35 patients originally, but five were found to be unresectable at operation. Of the remaining 30 patients, the tumour locations were: upper thoracic (1), midthoracic (24) and lower thoracic (5). The anastomotic sites were: above aortic arch (23), below aortic arch (5) and neck (2). The technical success of this procedure was good with no deaths in the immediate post-operative period. There were three anastomotic leakages which all healed after thoracic drainage and a feeding jejunostomy.