Experience of partial oesophagectomy in surgical treatment of lower and middle thoracic oesophageal cancer *1From a follow-up of 366 cases

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Abstract
Since carcinoma of the oesophagus is considered to be frequentlymulticentric, total oesophagectomy appears the only radical therapeuticalapproach. A follow-up of 366 patients who underwent partial oesophagectomyshows that this procedure can be curative as well as palliative and issometimes the only procedure possible with a reasonable mortality. Thesepatients had an oesophageal carcinoma located between the cardia and thelevel of the aortic arch (60.5% squamous, 37% adenocarcinoma). Of these,22% were over 70 years of age. The surgical route was a left thoracotomy in280 cases (with anastomosis below or above the aortic arch) or a laparotomyand right thoracotomy in 86 cases. The oesophagus was transected as high aspossible and replaced by an isoperistaltic tube fashioned from the greatercurvature of the stomach. Mediastinal tissues and the lesser curvature withtheir lymph nodes were removed. The overall operative mortality was 7% (4%in patients less than 70 and 15% over 70). Very few anastomotic fistulaewere observed (6 cases) but they were always severe (6 deaths). The middleand long term results show acceptable functional sequelae and a goodsurvival quality. The survival is 57% at 1 year, 30% at 3 years and 23% at5 years (27% when the excision appeared curative). There was no significantdifference in survival for patients whose cancer was in the mid-oesophaguscompared to the lower oesophagus. There was no difference in survival inthe cell type squamous or adenocarcinoma. Death was mainly due tometastatic lesions and mediastinal lymphatic recurrence.(ABSTRACT TRUNCATEDAT 250 WORDS)

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