Esophagectomy for carcinoma : a very long story

From the first cervical resection, by Czerny (1877), to the first successfulthoracic excision by Torek (1913), several surgeons in theworld, and especially Tuffier in France, experimented on the dogand studied respiratory consequences of thoracotomies. But allesophagus resections in men were mortal. Torek’s operation had ahigh mortality rate, a very rare long-time survival with the doubleinfirmity of a cervical esophagostomy and a gastrostomy.From 1933 (Oshawa) to 1945 (Sweet), a left thoracotomy withphrenotomy was performed. Immediate anastomosis was preferredby most surgeons. Mortality rate was high and only about fifteenoperations in the world were successful.After World War II, two international conventions, in the USA in1946, and in France in 1947 (Santy, Mouchet), noted importantprogress. It was less due to the surgeons’ dexterity than to the developmentof modern anaesthesia procedures (tracheal intubation;curare; assisted ventilation; closed circuit devices). Abdominal andright thoracic approach, the royal way allowed spreading the resectionsto the carcinoma of the middle esophagus. After 1953, thedevices of mechanical ventilation entailed indirectly the creation ofrespiratory, then polyvalent units. Independent anesthesiologistsand reanimators entered the team.During the period 1960-1978, an era of statistical and better selectionopened. The right approach emerged. But chiefly one notesmajor improvements of the instruments, needles, absorbable thread,mechanical tubulisation of the stomach, etc… Progress in flexibleendoscopy and imagery (echography, Scan) allowed for better selectionof patients for carcinoma resection. Radiotherapy, a moreefficient chemotherapy and endoscopic intubation were employedin therapeutic decisions that had become increasingly multidisciplinary.After the battle and the victory of mechanical anastomosis, resectionwithout thoracotomy and possible video-assisted esophagectomyconcludes this historical survey, although probably only temporarily.