Comparison of the results of esophagectomy with and without a thoracotomy.

Two techniques of esophagectomy for carcinoma of the esophagus were compared in 41 patients. Of these, 39 had chemotherapy or radiotherapy, or both, preoperatively. Overall, the 20 patients who had a blind esophagectomy through an abdominal and a cervical incision without a thoracotomy tolerated the procedure quite well. However, two patients died three and five weeks afterward of arrhythmia and respiratory insufficiency, respectively. None of the 21 patients having an esophagectomy by means of a standard thoracotomy died. The blind esophagectomy took an hour less to perform and required slightly more blood than the standard thoracic esophagectomy. Except for the one patient who died of respiratory insufficiency, it appeared that the patients not having a thoracotomy had less pulmonary complications and required less ventilator assistance. The length of stay was almost identical. The main advantages found were the ease of the operation, no change needed in the position of the patient and the shorter duration of the operation. Theoretic advantages, not yet confirmed, include decreased mortality and morbidity if an anastomotic leak occurs and decreased change of local recurrence of the carcinoma.