Gastrostomy and oesophagoplasty with a flap from the greater curvature of the stomach as stages of surgical and combined treatment of cancer of the thoracic oesophagus.

Four-hundred fifty-eight patients with cancer of the oesophagus were subjected to revisional laparotomy. Metastases into subphrenic lymph nodes were registered in 24% of the cases with a tumor in the bronchial segment; 42% with tumor in the subbronchial segment; 48% with tumor in the retropericardial segment; 71% with tumors in the sub-, intra-, and supraphrenic segments of the oesophagus. In 345 cases, laparotomy was followed by tube gastrostomy (Beck-Carrel method) with two operative deaths. Fifty-six patients in good condition with a small tumor in the middle part of the oesophagus (less than or equal to 5 cm) without any abdominal metastases were subjected to primary oesophagoplasty: a 30--32-cm tube was formed out of the greater curvature of the stomach and placed retrosternally; gastrostomy was performed on the level of the thyroid cartilage (without any operative deaths). In two weeks, extirpation of the thoracic part of the oesophagus (with preoperative irradiation) was performed on patients with no abdominal metastases. Then the patients with primary oesophagoplasty were subjected to oesophago-gastrostomy of the neck. From six to 12 months following the combined treatment, the gastrostomy tube of 45 patients was lengthened to 30--32 cm and used for retrosternal oesophagoplasty (six operative deaths). Oesophagoplasty was performed on 14 patients during the extirpation of the oesophagus (six operative deaths).