Left thoracotomy approach for resection of carcinoma of the esophagus.

One hundred and ten patients underwent gastroesophageal resections performed transdiaphragmatically by way of a left thoracotomy. Eighty-one patients had tumors distal to the inferior pulmonary vein and had en bloc dissections, while the remaining 29 had midthoracic tumors, which required a two-rib thoracotomy. There were 73 men and 37 women with a median age of 64 years (a range of 40 to 75 years). The postoperative mortality rate was 2.7 per cent, and morbidity, mainly caused by respiratory complications, occurred in 21 patients (19 per cent), with no patients requiring ventilatory support. There were no anastomotic leaks. Adequate analgesia was provided by the use of a subpleural catheter delivering a continuous infusion of bupivacaine. The left thoracotomy provides an effective method for undertaking esophageal resections with low mortality and morbidity rates. This approach should be more widely used in the surgical management of patients with intrathoracic esophageal tumors.