Left thoracotomy approach for resection of carcinoma of the oesophagus and cardia.

Oesophagogastrectomy is the best available treatment for patients with carcinoma of the oesophagus or cardia. It provides better longevity than other types of therapy and remains the standard against which combined modality treatment should be compared. Our experience with two hundred and twenty-four patients who underwent surgical exploration performed transdiaphragmatically by way of a left thoracotomy formed the basis of this report. Of these 224 patients, 201 (89.7%) underwent resection, 15 were bypassed and the remaining 5 patients were intubated. Of those resected, 79 patients required a two-rib thoracotomy. The postoperative mortality rate was 3.57%, and morbidity, mainly caused by respiratory complications occurred in 36 patients (16.1%), with no patients requiring ventilatory support. Surgical bypass without resection carried a higher mortality rate (8.3%) than those for resection (2.5%). All anastomosis were hand sewn. There were no anastomotic leaks. Adequate analgesia was provided by continuous extrapleural intercostal nerve block. Five year survival for squamous carcinoma was 36% while that adenocarcinoma was 18.7%. The left thoracotomy provides an effective method for undertaking oesophageal resections with low mortality and morbidity rates. This techniques has advantages and should be more widely used in the surgical management of patients with carcinoma of the oesophagus or cardia.