Problems in esophageal bypass for unresectable carcinoma of the thoracic esophagus.

The clinical evaluation of esophageal reconstruction in both resectable and unresectable carcinoma of the thoracic esophagus is described. Our operative technique for obtaining a long gastric tube and creating and end-to-side anastomosis has been highly successful, and the anastomotic failure rate was remarkably lowered in patients with resectable carcinoma of the esophagus. However, anastomotic leakage remains a serious problem for those undergoing esophageal bypass for unresectable carcinoma of the esophagus. The most likely cause of anastomotic failure after bypass seems to be the tug on the anastomosis with each swallow.