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Esophagectomy Without Thoracotomy Using the Cervicoabdominal Approach for the Management of Esophageal Carcinoma: Results

  • B. Zilberstein
  • I. Cecconello
  • W. Pollara
  • C. E. Domene
  • A. Nasi
  • H. W. Pinotti

Abstract

Obstructive diseases, especially neoplasms of the esophagus, frequently cause serious nutritional disturbances, besides the associated pulmonary changes due to aspiration of stagnant esophageal content. In addition, neoplasms occur in an older age group with a higher incidence of chronic obstructive pulmonary disease. Therefore, in these patients, there is a higher risk of postoperative pulmonary complications when performing esophagectomy via thoracotomy. Pain from thoracotomy also contributes, resulting in decreased ventilation and accumulation of secretions and pleural effusions; also the patient’s lateral position during the operation causes hypoventilation of the contralateral lung and passage of secretions from the compressed lung to the other. In order to eliminate these drawbacks, we remove the esophagus via a cervicoabdominal approach without thoracotomy [2]. This approach also allows the surgical staging of the neoplasm, with visualization of the lymph nodes of the lesser curvature, celiac trunk, and the hepatic parenchyma, and it provides better assessment of resectability without the need for thoracotomy.

Keywords

Chronic Obstructive Pulmonary Disease Esophageal Cancer Celiac Trunk Surgical Staging Cervical Esophagus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Earlam R, Cunha-Mello J (1980) Oesophageal squamous cell carcinoma: a critical review of surgery. Br J Surg 67:381–990PubMedCrossRefGoogle Scholar
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    Pinotti HW (1977) Esofagectomia subtotal por tunel transmediastinal sem toracotomia. AMB 23:395–398PubMedGoogle Scholar
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    Pinotti HW, Ellenbogen G, Zilberstein B, Pollara WM, Gama-Rodrigues JJ, Raia AA (1978) Esophagectomy by cervico-abdominal approach; incision of diaphragm and transmediastinal extrapleural dissection. Chir Gastroenterol 12:223–232Google Scholar
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    Pinotti HW, Zilberstein B, Pollara WM, Raia A A (1981) Esophagectomy without thoracotomy. Surg Gynecol Obstet 152:344–346PubMedGoogle Scholar
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    Zilberstein B, Pollara WM, Cecconello I, Nasi A, Brandt F, Oliveira MA, Domene CE, Pinotti HW (1986) Oral feeding in the treatment of upper digestive fistulas. ABCD 1:48–51Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • B. Zilberstein
    • 1
  • I. Cecconello
    • 1
  • W. Pollara
    • 1
  • C. E. Domene
    • 1
  • A. Nasi
    • 1
  • H. W. Pinotti
    • 1
  1. 1.Digestive Surgery UnitUniversity of São Paulo Medical SchoolSão PauloBrazil

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