Resection for carcinoma of the superior mediastinal segment of the esophagus

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Abstract
During the past 13 years, 86 patients with carcinoma of the esophagus situated at the superior mediastinal segment were admitted and treated at the Queen Mary Hospital, Hong Kong. Only 17 of these patients underwent resection. The resection technique was based on what was described in 1957 by Waddell and Scannell and by Cauchoix and Binet. The whole of the esophagus was removed in each case and the reconstruction, using the stomach, was accomplished by anastomosing the fundus to the cricopharyngeus. In 1 patient an isolated jejunal segment was used in the esophagoplasty, while in another the colon was utilized. There were 3 postoperative deaths, 1 due to a gastrotracheal fistula from erosion by the tracheostomy tube, a second due to hemorrhage, and a third due to bronchopneumonia. Four patients are currently alive and well without evidence of cancer. The longest survivor has lived for 5 years and 3 months. Ten of the patients who were discharged from the hospital lived for from 2 to 15 months, with an average of 8.7 months. This compares favorably with the 6.9 months average survival reported by Procter in patients with carcinoma of the upper third of the esophagus who were treated by radiotherapy. While the mortality rate is still high, the results are encouraging and continued use of surgical treatment is certainly warranted.