Successful Methods in Antethoracic Esophagogastrostomy following Subtotal Esophagectomy for Cancer of the Esophagus

¹ 2nd Surgical Division, Kyoto University Medical School (Director: Prof. Dr. Chuji Kimura)

When antethoracic esophagogastrostomy is performed according to Nakayama's method following subtotal esophagectomy for cancer of the upper and mid-thoracic esophagus, frequent occurrence of sutural insufficiency is more than 90 per cent of the total. Disturbance of blood circulation in the antethoracically transplanted Kirschner-Nakayama type of gastric tube, which is caused by bilateral vagotomy, etc., is mainly responsible for such sutural insufficiency. To cope with this sutural insufficiency, we made some investigations on the following methods: 1) intensive postoperative oxygen therapy, 2) revascularization of the tip of gastric tube by small vessel anastomosis, and, 3) periarterial sympathectomy of the right gastric and right gastroepiploic arteries. By using method 1 or method 2 combined with method 1 clinically, we could succeed in almost all of the ante- or intrathoracic esophagogastrostomies.