European Journal of Cardio-Thoracic Surgery, Vol 7, 601-604, Copyright © 1993 by European Association for Cardio-thoracic Surgery
Colon substitution for radical treatment of cardia and lower third esophageal cancer
A Cherveniakov and P Cherveniakov
Emergency Medical Institute, N. I. Pirogov, Sofia, Bulgaria.
During the past 24 years we have treated 786 patients with esophageal and
cardia carcinoma. En bloc resection of the tumor has been performed in only
461 (65.2%) of them and in 246 (34.7%) of the cases various palliative
operations have been undertaken. Most of the patients were in stage II or
III of the disease with squamous cell carcinoma in 80.5% and adenocarcinoma
in 19.5% of them. The method of choice for the treatment of the patients
with cardia and lower third of the esophagus carcinoma (n - 315) were blunt
esophagectomy followed by colon (n - 256), stomach (n - 54) and/or jejunal
(n - 9) substitution. The histology results confirmed the oncologic radical
zone of resection of the esophagus from 8 cm above the tumor to 10-12 cm
below in the stomach wall. This is the reason why substitution of the
esophagus with stomach tube is very often impossible and the colon
substitution remains the method of choice for such patients. The other
important factor is radical resection of the tumor with the surrounding
tissue, organs and lymph nodes involved (resection en bloc). The hospital
mortality included 28 patients (7.3%) from the radically operated who also
underwent esophageal substitution (n = 378). For these patients the 3-year
survival rate is 51% (n - 191) and 5-year survival 46% (n - 172).
