Right Colon Used as an Esophageal Prosthesis
LAURENCE K. GROVES, M.D.
Department of Thoracic Surgery
RUPERT B. TURNBULL, M.D.
Department of General Surgery
A large part of esophageal surgery is concerned with restoration of a relatively normal function of swallowing by substituting other organs for the esophingenuity and daring,1–3 but it is beyond the scope of this paper. In general, the evolution of surgical technics has led to the use of the mobilized stomach as the esophageal substitute of choice.
In the surgical treatment of carcinoma of the esophagus the primary mission is to perform the best cancer operation possible, and, secondarily to re-establish gastrointestinal continuity quickly and safely. To accomplish the second goal, there is no substitute for the stomach. A complete cancer operation in the thoracic esophagus involves the mobilization and resection of the principal areas of lymphatic drainage, most important of which is the chain of nodes reaching down along the left gastric vessels to the superior border of the pancreas. When this has been accomplished, mobilization of the stomach is approximately one half achieved and it is easy to complete the procedure.
Most patients adjust satisfactorily to the thoracic stomach created for the above-described purpose, particularly if a pyloroplasty is performed. However, there are other conditions, usually occurring in young patients, frequently involving most of or upper portions of the esophagus, and all of a benign cause, in which other approaches to the problem offer at least theoretic advantages. Hopefully, these lesions are associated with a normal life span, and the reservoir and digestive functions of the stomach presumably operate best in a normal anatomic situation. Also, there . . .