Ann Thorac Surg
CORRESPONDENCE
1991;51:159-63
carefully evaluated before subjecting the recipient of such implant to a high-field-strength magnetic resonance scan. We appreciate the comments of Dr Weber and his discussion of this important topic.
Iefiey P. Gold, M D Division of Cardiothoracic Surgery The New York Hospital-Cornell Medical Center 525 E 68th St New York, NY 10021
Esophagogastrectomy via Left Thoracotomy To the Editor: My colleagues and I read with interest the paper by Page and associates [ l ] entitled "Esophagogastrectomy via left thoracophrenotomy." We congratulate Page and associates on their good results. However, they state "Although this approach [the left thoracophrenotomy] is still practiced by some thoracic surgeons on both sides of the Atlantic, little appears in the literature about this technique." May I draw your attention to the fact that this technique was described and published in 1983 in the Annals of Surgery [2], where it was stated "In the latter part of the series [ie, in 23 patients], all lesions, irrespective of their location, were approached through the left chest. This approach is easy and adequate to provide access both to the esophagus and to the stomach. Second, it has less postoperative respiratory complications compared with a two-stage procedure. Third, if the tumor is behind the aortic arch, the aorta can be mobilized easily, and anastomosis with the help of the stapler can be achieved either below, above, or lateral to the arch. Finally, if the lesion is unresectable, a Celestin tube can be placed in position through the same incision."
R . Behl, M S , FRCS(Eng) Newcastle Freeman Hospital High Heaton Newcastle Upon Tyne NE7 7DN England
References 1. Page RD, Khalil JF, Whyte RI, Kaplan DK, Donnelly RJ. Esophagogastrectomy via left thoracotomy. Ann Thorac Surg 1990;49:763-6.
Reply
To the Editor:
1 am pleased to respond to the letter of Mr Behl in which he refers to our paper reporting 115 patients who underwent esophagogastrectomy for malignant disease through a left thoracotomy incision. We were aware of the paper by Behl and his colleagues and, indeed, referred to this in our previous paper, published in
163
Thorax [I]. Others have also reported results of this technique, and we did not make any claims to originality. The purpose in presenting our results for publication was to draw attention again to the technique at a time when most reports refer to the transhiatal, thoracoabdominal, or lvor Lewis approaches to esophageal resection. The left thoracotomy approach was first described in the early days of esophageal surgery, and 1 would entirely agree with Mr Behl regarding its advantages. It is true, however, that only occasional reports of the technique appear in the surgical literature these days, and l hope that our contribution will help, with others, to maintain the position of the operation in modern thoracic surgery. R. 1. Donnelly, M B , FRCS(Ed) Broadgreen Hospital Thoinas Drizw Liverpool L14 3LB England Reference 1. Donnelly RJ, Sastry MR, Wright CD. Oesophagogastrectomy using the end to end anastomotic stapler: results of the first 100 patients. Thorax 1985;40:958-9.
Symposium on Thoracic Surgical Oncology To the Editor: I would like to bring to the attention of The Annals an error of omission in the Symposium of Thoracic Surgical Oncology [l]. Due to editorial constraints two important members of the Surgery Branch who made valuable contributions before the Thoracic Oncology Section was established were omitted. These include Dr M. Wayne Flye and Dr Michael R. Johnston. These thoracic surgeons were in the Surgery Branch as Senior Investigators between 1977 and 1982. During that interval it was recognized that the volume of thoracic surgery at the National Cancer Institute demanded the establishment of a Thoracic Oncology Section which Dr Roth, indeed, established in 1981. I felt it was important to bring this to your attention, particularly because both these gentlemen have established themselves not only as technically superb surgeons but also as innovators in the field of thoracic oncology. Harvey I . Pass. M D Thoracic Oncology Section Surgery Branch National Cancer InstitutelNlH Building 10, Rooin 2B07 Bethesda, M D 20892 Reference 1. Symposium on Thoracic Surgical Oncology [Report]. Ann Thorac Surg 1990;50:500-7.
CORRESPONDENCE
1991;51:159-63
carefully evaluated before subjecting the recipient of such implant to a high-field-strength magnetic resonance scan. We appreciate the comments of Dr Weber and his discussion of this important topic.
Iefiey P. Gold, M D Division of Cardiothoracic Surgery The New York Hospital-Cornell Medical Center 525 E 68th St New York, NY 10021
Esophagogastrectomy via Left Thoracotomy To the Editor: My colleagues and I read with interest the paper by Page and associates [ l ] entitled "Esophagogastrectomy via left thoracophrenotomy." We congratulate Page and associates on their good results. However, they state "Although this approach [the left thoracophrenotomy] is still practiced by some thoracic surgeons on both sides of the Atlantic, little appears in the literature about this technique." May I draw your attention to the fact that this technique was described and published in 1983 in the Annals of Surgery [2], where it was stated "In the latter part of the series [ie, in 23 patients], all lesions, irrespective of their location, were approached through the left chest. This approach is easy and adequate to provide access both to the esophagus and to the stomach. Second, it has less postoperative respiratory complications compared with a two-stage procedure. Third, if the tumor is behind the aortic arch, the aorta can be mobilized easily, and anastomosis with the help of the stapler can be achieved either below, above, or lateral to the arch. Finally, if the lesion is unresectable, a Celestin tube can be placed in position through the same incision."
R . Behl, M S , FRCS(Eng) Newcastle Freeman Hospital High Heaton Newcastle Upon Tyne NE7 7DN England
References 1. Page RD, Khalil JF, Whyte RI, Kaplan DK, Donnelly RJ. Esophagogastrectomy via left thoracotomy. Ann Thorac Surg 1990;49:763-6.
Reply
To the Editor:
1 am pleased to respond to the letter of Mr Behl in which he refers to our paper reporting 115 patients who underwent esophagogastrectomy for malignant disease through a left thoracotomy incision. We were aware of the paper by Behl and his colleagues and, indeed, referred to this in our previous paper, published in
163
Thorax [I]. Others have also reported results of this technique, and we did not make any claims to originality. The purpose in presenting our results for publication was to draw attention again to the technique at a time when most reports refer to the transhiatal, thoracoabdominal, or lvor Lewis approaches to esophageal resection. The left thoracotomy approach was first described in the early days of esophageal surgery, and 1 would entirely agree with Mr Behl regarding its advantages. It is true, however, that only occasional reports of the technique appear in the surgical literature these days, and l hope that our contribution will help, with others, to maintain the position of the operation in modern thoracic surgery. R. 1. Donnelly, M B , FRCS(Ed) Broadgreen Hospital Thoinas Drizw Liverpool L14 3LB England Reference 1. Donnelly RJ, Sastry MR, Wright CD. Oesophagogastrectomy using the end to end anastomotic stapler: results of the first 100 patients. Thorax 1985;40:958-9.
Symposium on Thoracic Surgical Oncology To the Editor: I would like to bring to the attention of The Annals an error of omission in the Symposium of Thoracic Surgical Oncology [l]. Due to editorial constraints two important members of the Surgery Branch who made valuable contributions before the Thoracic Oncology Section was established were omitted. These include Dr M. Wayne Flye and Dr Michael R. Johnston. These thoracic surgeons were in the Surgery Branch as Senior Investigators between 1977 and 1982. During that interval it was recognized that the volume of thoracic surgery at the National Cancer Institute demanded the establishment of a Thoracic Oncology Section which Dr Roth, indeed, established in 1981. I felt it was important to bring this to your attention, particularly because both these gentlemen have established themselves not only as technically superb surgeons but also as innovators in the field of thoracic oncology. Harvey I . Pass. M D Thoracic Oncology Section Surgery Branch National Cancer InstitutelNlH Building 10, Rooin 2B07 Bethesda, M D 20892 Reference 1. Symposium on Thoracic Surgical Oncology [Report]. Ann Thorac Surg 1990;50:500-7.
