The stomach as an esophageal substitute after total or subtotal esophagectomy : comparison between the gastric tube and the whole stomach

The thesis addresses two main questions of major clinical importance regarding the surgical treatment of esophageal cancer: 1. What is the potential of esophagectomy including extensive thoraco-abdominal lymph node clearance to provide oesophageal cancer patients with long-term survival and cure? 2. What are the qualities of the stomach as an esophageal substitute after total or subtotal esophagectomy regarding surgical feasibility, technical complications, and alimentary comfort? In the introduction, we reviewed the current knowledge according to the world literature concerning, vasculature, innervation and mobility of the stomach which is required for a clear understanding of the to issued presently studied. The review of a personal series of 306 esophagectomies performed for malignancy showed that resection of the esophagus en-bloc with the loco-regional lymph nodes was technically feasible in 213 patients (70%). Five-year survival rate after radical esophagectomy was 70% for the 104 patients having no lymph node involvement (T1-T2-T3-N0) and 31% for the 109 patients having metastatic lymph nodes. (T1, T2, T3, N1). Five-year survival rates improved with increasing experience on the procedures over the years. Comparison of results obtained form 1984 to 1988 with those from 1989 to 1997 showed that the 5-year survival rate increased form 63.6% to 75.5% for patients classified N0 and from 17.5% to 39% for those classified N1. Replacement of the esophagus with the stomach is governed by anatomical constraints in relation to the shape, vascularisation and innervation of the organ, the distance to bridge between the abdomen and the neck, and the need for complete lymphatic clearance of the lesser curvature. We have compared the classic technique of gastric tubulisation with stapling resection of the lesser curvature to a personal technique in which the lesser curvature of the whole stomach is denuded for the purpose of gastric lengthening and l
Thèse d'agrégation de l'enseignement supérieur (Faculté de médecine) -- UCL, 1997