Intrathoracic esophagojejunostomy following the resection of the lower esophagus—Tohru Ohsawa,pioneer in surgery of the esophagus

In 1929 Ohsawa of Kyoto performed an intrathoracic esophagojejunostomy on a 52-year-old male through the thoracoabdominal route. This was the first successful case of anastomosis between the intrathoracic esophagus and the intra-abdominal digestive tract, previously attempted so many times the world over. This marked the opening of the era of esophageal surgery. As early as 1938, Ohsawa detected esophageal cancer of 1 × 2 cm size by fluoroscopy. Successful surgery on this tumor highlighted the ultimate approach for the satisfactory treatment of esophageal cancer, i.e., early detection and early treatment.

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Resumen En 1929 Ohsawa de Kioto realizó una gastrectomía total con esofagoyeyunostomía intratorácica por vía toracoabdominal en un hombre de 52 años. Así se logró por primera vez con éxito la anastomosis entre el esófago intratorácico y el tracto digestivo intraabdominal, lo cual había sido intentado en tantas ocasiones previas en todo el mundo. Ello señaló el comienzo de la era de la cirugía esofágica. En 1938 Ohsawa detectó un cáncer de 1 × 2 cm por medio de fluoroscopia con bario mezclado con aceite de oliva; el paciente fué operado exitosamente, demostrando así el enfoque definitivo para el tratamiento adecuado del cáncer esofágico: el diagnóstico y tratamiento precoces.

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Résumé Dès 1929, Ohsawa de Kyoto réalisa une oesophagojejunostomie intrathoracique par voie thoraco-abdominale chez un homme de 52 ans. Cette opération représenta le premier cas réussi d'anastomose entre l'oesophage intrathoracique et un segment intraabdominal, du tube digestif. Il constitua l'étape initiale de la chirurgie oesophagienne. Dès 1938, Ohsawa décelait un cancer oesophagien de petite dimension (1 × 2 cm) grâce à l'exploration radiologique et l'opérait avec succès. Il démontrait ainsi que le succès du traitement du cancer de l'oesophage dépendait essentiellement de la précocité du diagnostic et de l'acte thérapeutique.

     

Intrathoracic esophagojejunostomy using OrVil? for gastric adenocarcinoma involving the esophagus

AIM: To demonstrate a new surgical technique of lower mediastinal lymphadenectomy and intrathoracic anastomosis of esophagojejunostomy using OrVil™.METHODS: After a total median phrenotomy, the supradiaphragmatic and lower thoracic paraesophageal lymph nodes were transhiatally dissected. The esophagus was cut off using a liner stapler and OrVil™was inserted. Finally, end-to-side esophagojejunostomy was created by using a circular stapler. From July 2009, we adopted this surgical technique for five patients with gastric cancer involving the lower esophagus.RESULTS: The median operation time was 314 min (range; 210-367 min), and median blood loss was 210 mL (range; 100-838 mL). The median numbers of dissected lower mediastinal nodes were 3 (range; 1-10). None of the patients had postoperative complications including anastomotic leakage and stenosis. The median hospital stay was 16 d (range: 15-20 d). The median length of esophageal involvement was 14 mm (range: 6-48 mm) and that of the resected esophagus was 40 mm (range: 35-55 mm); all resected specimens had tumor-free margins.CONCLUSION: This surgical technique is easy and safe intrathoracic anastomosis for the patients with gastric adenocarcinoma involving the lower esophagus.     

Palliative retrosternal reconstruction in cancer of the esophagus

Among patients presenting with a cancer of the esophagus, only a third will have a theoretical radical resection. Out of our management: 1 - By pass with operatory abdominal and cervical check up--2 - Chemotherapy--3 - Total esophageal resection by thoracotomy, 29 patients get through the first stage only, which is then considered as a palliation method. Results obtained about the degree of palliation, i.e. quality of life, pathologic incidences, mortality rates are compared with other methods.     

Reconstructive surgery of the esophagus in patients with combined chemical burns of the esophagus and stomach

The article generalizes the experience in the treatment of 317 patients with burns of the esophagus and stomach, 140 of them underwent restorative operations on the esophagus. The indications for the choice of the restorative operations are determined by the character of the burn and the condition of the patient's organism before the accident. Retrosternal plastics of the esophagus with the colon is the operation of choice in this group of patients. The elaboration of rational therapeutic tactics, improvement of preoperative management, and the introduction of effective methods of treatment into practice with the use of microsurgical and laser techniques improved considerably the results of restorative operations on the esophagus in patients with combined burn pathology.     

The stomach as replacement of the esophagus in esophageal cancer

The advantage in using the stomach as an oesophageal substitute are demonstrated by operative technique, function and physiology. The preference of the stomach in oesophageal replacement is based upon a lot of experimental and clinical experiences, which are mentioned.