Development of cervical bronchostomy in relation to canine pulmonary transplantation

Abstract

This short series gives some support to the view that limited excision with postoperative radiotherapy is a form of treatment worthy of consideration. The efficacy of radiotherapy is inversely proportional to the volume of the tumour. It is logical to consider, as has been done particularly with carcinoma of the breast, that local excision and radiotherapy may be preferable to either treatment by itself. Two of our patients are of interest in this connexion. One (Case 9) had local recurrence which was apparently eradicated by radiotherapy. The other (Case IO), in whom there was histological evidence of inadequate excision, did not develop recurrence at the anastomosis.Surgical treatment for oesophageal carcinoma should achieve freedom from dysphagia. A disadvantage of limited excision with end-to-end anastomosis is that the incidence of postoperative dysphagia is probably greater than with other procedures. The method carries not only the risk of local recurrence but also the risk of dysphagia from fibrous stricture formation at the suture line. Dysphagia may, of course, occur from peptic stricture following oesophagogastrostomy but is rare after oesophagojejunostomy. When a stricture does form after end-to-end oesophageal anastomosis it is often web-like and responds well to dilatation.The operation, therefore, has certain disadvantages. It is limited in its application, being suitable only for the somewhat rare, small hard growth. The operation contravenes the rule of wide excision in cancer surgery. It is probably associated with a higher incidence of postoperative dysphagia than oesophagogastrostomy or oesophageal replacement with jejunum or colon.It has advantages. It is a relatively short procedure and, when practicable, is suitable for very old and very ill patients. When it is successful the patient is left with a normal alimentary tract, apart from the possible effects of vagotomy. His nutrition is excellent. He does not suffer from anaemia of either sideropenic or megaloblastic type. There are no late sequelae from derangement of calcium metabolism. He does not suffer from oesophagitis. The 3 long survivors in the present series are the best results of surgery for oesophageal cancer which the author has achieved by any type of operation.It cannot be overemphasized that any attempt to extend the indications for this operation is doomed to failure. SUMMARY Ten patients are described in whom a carcinoma of the oesophagus was resected with end-to-end oesophageal anastomosis. In 4 patients the operation was combined with postoperative radiotherapy.The selection of suitable cases is outlined. A technique of anastomosis is described.The advantages and disadvantages of the operation are discussed.