Appraisal of the simultaneous right-thoracic and abdominal approach with intrathoracic reconstruction after esophageal resection for patients with intrathoracic esophageal cancer.

Background/aims: This study evaluated the surgical procedure with the simultaneous right-thoracic and abdominal approaches with intrathoracic reconstruction after performing a macroscopically curable esophageal resection and a mediastio-abdominal extended lymphadenectomy as the standard operation for patients with intrathoracic esophageal cancer.

Methodology: Forty-seven patients with thoracic esophageal cancer were operated on at the Department of Surgery I, Gunma University Hospital from 1995 to 1999. Before the end of 1997, all 21 cases underwent subtotal esophagectomy with three-field lymphadenectomy. After 1998, however, 16 cases underwent the same procedure while the remaining 10 underwent a simultaneous right-thoracic and abdominal approach with intrathoracic reconstruction with lymphadenectomy based on our criteria (Group I). Postoperative factors including the data of cytokines were compared between Group I and conventional subtotal (10 cases) esophagectomy with three-field lymphadenectomy (Group II, 37 cases).

Results: None of the patients in Group I has shown a recurrence of cancer. The CRP levels at 2 POD and the serum IL 6 levels at 3 POD were significantly lower in Group I than in Group II (p<0.05), and the postoperative duration of mechanical ventilation was also significantly shorter in Group I than in Group II (p<0.001). The postoperative body weight gain at 12 months after surgery was also higher in Group I than in Group II.

Conclusions: This procedure is indicated for patients with esophageal cancer, located in the middle- or lower-thoracic esophagus, limited to within the esophageal wall, and without either upper mediastinal or neck lymph node metastasis, in order to not only cure the cancer but also in order to improve the postoperative quality of life.