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. 1987 Aug;206(2):184–192. doi: 10.1097/00000658-198708000-00011

Esophagectomy without thoracotomy: is there a risk of intramediastinal bleeding? A study on blood supply of the esophagus.

D M Liebermann-Meffert, U Luescher, U Neff, T P Rüedi, M Allgöwer
PMCID: PMC1493118  PMID: 3606244

Abstract

In transhiatal blunt esophagectomy there is surprisingly little bleeding if no adjacent great vessels are torn. This prompted an investigation by new injection techniques and corrosion on the human esophageal vasculature three-dimensionally. The three main arterial sources were confirmed: the superior thyroid artery, bronchial arteries at the level of the carina, and the left gastric and splenic artery. Two facts became obvious that were not appreciated hitherto. All major vascular trees divide into minute branches at some distance from the esophagus. Those branches go on to form a dense submucosal interconnected network. It appears that such small extraesophageal branches, when torn, will have the benefit of contractile hemostasis. Previous claims made that essential nutritional vessels arise from intercostal phrenic arteries or the aorta directly could not be confirmed. These findings would confirm blunt esophagectomy for tumors within the wall of the organ as a relatively safe procedure in terms of bleeding hazards.

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187Figs. 3A and B.
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188Figs. 5A-D.
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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akiyama H., Sato Y., Takashashi F. Immediate pharyngogastrostomy following total esophagectomy by blunt dissection. Jpn J Surg. 1971 Sep;1(3):225–231. doi: 10.1007/BF02468912. [DOI] [PubMed] [Google Scholar]
  2. Akiyama H. Surgery for carcinoma of the esophagus. Curr Probl Surg. 1980 Feb;17(2):53–120. doi: 10.1016/s0011-3840(80)80025-6. [DOI] [PubMed] [Google Scholar]
  3. Bains M. S., Spiro R. H. Pharyngolaryngectomy, total extrathoracic esophagectomy and gastric transposition. Surg Gynecol Obstet. 1979 Nov;149(5):693–696. [PubMed] [Google Scholar]
  4. Colas M., Carret J. P., Picq P., Le Pivert P., Cuilleret J. Etude de la vascularisation artérielle de l'oesophage par micro-angiographie. Bull Assoc Anat (Nancy) 1976 Sep;60(170):489–496. [PubMed] [Google Scholar]
  5. Cordiano C., Fracastoro G., Mosciaro O., Mozzo W. Esophagectomy and esophageal replacement by gastric pull-through procedure. Int Surg. 1979 Apr;64(3):17–25. [PubMed] [Google Scholar]
  6. Ellis F. H., Jr, Gibb S. P. Esophagogastrectomy for carcinoma: current hospital mortality and morbidity rates. Ann Surg. 1979 Dec;190(6):699–705. doi: 10.1097/00000658-197912000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Finley R. J., Grace M., Duff J. H. Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus. Surg Gynecol Obstet. 1985 Jan;160(1):49–56. [PubMed] [Google Scholar]
  8. GLOOR F. Die Gefässversorgung der Speiseröhre. Thoraxchirurgie. 1953 Jun;1(2):146–167. doi: 10.1055/s-0028-1096151. [DOI] [PubMed] [Google Scholar]
  9. Geel C., Leutenegger A. F., Rüedi T. Erste Erfahrungen mit der Magenersatzplastik beim Osophaguskarzinom ohne Thorakotomie. Helv Chir Acta. 1984 Apr;51(1):17–20. [PubMed] [Google Scholar]
  10. Hermreck A. S., Crawford D. G. The esophageal anastomotic leak. Am J Surg. 1976 Dec;132(6):794–798. doi: 10.1016/0002-9610(76)90461-x. [DOI] [PubMed] [Google Scholar]
  11. Kirk R. M. Palliative resection of oesophageal carcinoma without formal thoracotomy. Br J Surg. 1974 Sep;61(9):689–690. doi: 10.1002/bjs.1800610904. [DOI] [PubMed] [Google Scholar]
  12. Lam K. H., Cheung H. C., Wong J., Ong G. B. The present state of surgical treatment of carcinoma of the oesophagus. J R Coll Surg Edinb. 1982 Nov;27(6):315–326. [PubMed] [Google Scholar]
  13. MACMANUS J. E., DAMERON J. T., PAINE J. R. The extent to which one may interfere with the blood supply of the esophagus and obtain healing on antastomosis. Surgery. 1950 Jul;28(1):11–23. [PubMed] [Google Scholar]
  14. Miura T., Grillo H. C. The contribution of the inferior thyroid artery to the blood supply of the human trachea. Surg Gynecol Obstet. 1966 Jul;123(1):99–102. [PubMed] [Google Scholar]
  15. Neff U., Liebermann-Meffert D., Tondelli P., Harder F. Gefässanatomische Grundlagen der Osophagektomie ohne Thorakotomie. Helv Chir Acta. 1985 Jan;51(6):737–741. [PubMed] [Google Scholar]
  16. Orringer M. B., Orringer J. S. Esophagectomy without thoracotomy: a dangerous operation? J Thorac Cardiovasc Surg. 1983 Jan;85(1):72–80. [PubMed] [Google Scholar]
  17. Orringer M. B., Sloan H. Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg. 1978 Nov;76(5):643–654. [PubMed] [Google Scholar]
  18. Pinotti H. W., Zilberstein B., Pollara W., Raia A. Esophagectomy without thoracotomy. Surg Gynecol Obstet. 1981 Mar;152(3):344–346. [PubMed] [Google Scholar]
  19. Postlethwait R. W. Complications and deaths after operations for esophageal carcinoma. J Thorac Cardiovasc Surg. 1983 Jun;85(6):827–831. [PubMed] [Google Scholar]
  20. SHAPIRO A. L., ROBILLARD G. L. The esophageal arteries their configurational anatomy and variations in relation to surgery. Ann Surg. 1950 Feb;131(2):171-85, illust. doi: 10.1097/00000658-195002000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. SWIGART L. L., SIEKERT R. G. The esophageal arteries; an anatomic study of 150 specimens. Surg Gynecol Obstet. 1950 Feb;90(2):234-43, illust. [PubMed] [Google Scholar]
  22. SZABO L. E., KARACSONYI S., PATAKY Z. [On the esophageal blood supply and its surgical significance]. Zentralbl Chir. 1961 Feb 4;86:619–626. [PubMed] [Google Scholar]
  23. Steiger Z., Wilson R. F. Comparison of the results of esophagectomy with and without a thoracotomy. Surg Gynecol Obstet. 1981 Nov;153(5):653–656. [PubMed] [Google Scholar]
  24. Szentpetery S., Wolfgang T., Lower R. R. Pull-through esophagectomy without thoracotomy for esophageal carcinoma. Ann Thorac Surg. 1979 May;27(5):399–403. doi: 10.1016/s0003-4975(10)63333-4. [DOI] [PubMed] [Google Scholar]
  25. Thomas A. N., Dedo H. H. Pharyngogastrostomy for treatment of severe caustic stricture of the pharynx and esophagus. J Thorac Cardiovasc Surg. 1977 Jun;73(6):817–824. [PubMed] [Google Scholar]
  26. Tryzelaar J. F., Neptune W. B., Ellis F. H., Jr Esophagectomy without thoracotomy for carcinoma of the esophagus. Am J Surg. 1982 Apr;143(4):486–489. doi: 10.1016/0002-9610(82)90200-8. [DOI] [PubMed] [Google Scholar]
  27. Ulrich B., Kasperk R., Grabitz K., Kremer K. Die Oesophagusresektion ohne Thoracotomie beim Carcinom. Erfahrungsbericht über 100 Fälle. Chirurg. 1985 Apr;56(4):251–260. [PubMed] [Google Scholar]
  28. Vallée B., Hong R., Renelier B., Person H., Nguyen H. Les artères oesophagiennes d'origine cervicale. Etude anatomique de 23 dissections. Ann Otolaryngol Chir Cervicofac. 1982;99(1-2):29–34. [PubMed] [Google Scholar]
  29. Williams D. B., Payne W. S. Observations on esophageal blood supply. Mayo Clin Proc. 1982 Jul;57(7):448–453. [PubMed] [Google Scholar]

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