• Journal of Chest Surgery
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• v.14 no.3
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• pp.202-209
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• 1981

The results of reconstruction of the lower esophagus with jejunum in a total of 24 cases of primary carcinoma of the lower third esophagus and gastroesophageal carcinoma were presented, and clinical values of substitution for the esophagus with jejunum were also discussed. They were operated in the department of thoracic and cardiovascular surgery, Hanyang University Hospital during the period of 9 years from 1972 to 1981. Surgical managements to lower esophageal reconstruction with jejunum were carded out with not the same procedure in all cases studied, but with three different procedure mentioned below/ In 13 cases of lower third esophagectomy with or without partial `8astrectomy of a total of 24 cases, interposition of jejunum between the esophagus and the stomach were performed after the fashion to esophagojejunostomy with mobilized jejunal loops and 8astro-JeJunostomy with side to side anastomosis. In 7 cases of lower third esophagectomy and total gastrectomy, the continuity of the esophagus were performed the fashion to esophagojejunostomy with mobilized jejunum. In 4 cases of unresectable gastro-esophageal carcinoma, bypass operation of the lower esophagus and the stomach were performed after the fashion to esophagojejunostomy with side to and anastomosis. After the bypass operation, it was observed that oral feeding to the patients was excellent. Following these consecutive series of 20 cases of radical operation for lower esophageal carcinomas and 4 cases of bypass operation for unresectable gastroesophageal carcinomas, no complication such as postoperative leakage and stenosis from anastomotic site or Infection In operating area and operative death were observed.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.47-53
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• 1998

Despite of technical advances in surgery & other therapeutic modalities five-year survival rates in patients with carcinoma of hypopharynx have remained low. Many techniques have been used to create a structure capable of allowing the passage of food and fluids in an attempt to maintain the anatomy and physiology of the upper digestive system. The development of microsurgical techniques and the concept of mucocutaneous unit has brought about important changes in the reconstruction of cervical esophagus following tumor resection. The one-stage procedure using microvascular anastomosis of free jejunal graft provides physiologic reconstruction of cervical esophagus and has a low morbidity rate as well as a short recuperation time. With free jejunal graft, there is marked improvement in the quality of life and numerous advantages over the previous methods of reconstruction. Reconstruction of esophageal defect after resection of carcinomas of the hypopharynx, and cervical esophagus has traditionally been carried out with deltopectoral, or musculocutaneous skin-lined flaps. A second approach is to reconstruct the defect with the colon or stomach. A more ideal mettled is to repair these defects with mucosa-lined flaps. The authors experienced 35 cases of reconstruction of cervical esophagus after resection of carcinoma of the hypopharynx with free jejunal autograft and one case of secondary repair with radial forearm free flap after failure of initial free Jejunal autograft. Postoperative results were satisfactory in most patients and two patients expired in 8 days postoperatively because of carotid blow out by chronic inflammation.

• Journal of Gastric Cancer
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• v.19 no.4
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• pp.473-483
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• 2019

Surgical therapy for adenocarcinoma of the esophagogastric junction II requires distal esophagectomy, in which a transhiatal management of the lower esophagus is critical. The 'dorsal track control' (DTC) maneuver presented here facilitates the atraumatic handling of the distal esophagus, in preparation for a circular-stapled esophagojejunostomy. It is based on a ventral semicircular incision in the distal esophagus, with an intact dorsal wall for traction control of the esophagus. The maneuver facilitates the proper placement of the purse-string suture, up to its tying (around the anvil), thus minimizing the manipulation of the remaining esophagus. Furthermore, the dorsally-exposed inner wall surface of the ventrally-opened esophagus serves as a guiding chute that eases anvil insertion into the esophageal lumen. We performed this novel technique in 21 cases, enabling a safe anastomosis up to 10 cm proximal to the Z-line. No anastomotic insufficiency was observed. The DTC technique improves high transhiatal esophagojejunostomy.

• Journal of Chest Surgery
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• v.5 no.1
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• pp.45-56
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• 1972

Esophageal perforation is one of the most grave prognostic problems among thoracic and general surgical emergencies which necessitate urgent operative measures. In Korea,there are still many persons ingesting lye for suicidal attempt and thoracic surgeons in Korea have more chances to deal with lye burned esophagus with or without instrumental perforation than those in Western countries. Main cause of esophageal perforation in Korea is instrumental perforation in patients with lye stricture of the esophagus during diagnostic endoscopy or therapeutic bouginage. Other causes are corrosion of the esophagus due to ingestion of caustic agents, pathologic perforation, surgical trauma, stab wound and spontaneous rupture of the esophagus in our series. Therapeutic measures are various,and depend on duration of perforation, severity of its complications, pathology of perforated portion of the esophagus and degrees of inflammation at the point of perforation. The most important therapeutic measures are prevention of this grave condition during esophagoscopy, bouginage and surgical procedures on lungs and mediastinal structures and to make early diagnosis with prompt therapeutic measures. During the period of January, 1959, to December, 1971, the authors experienced 65 cases ofesophageal perforation including acquired esophagorespiratory fistula at Dept. of Chest Surgery, the National Medical Center in Seoul, and obtained following results in the series. 1. Female were 35 cases, and peak age incidence was 2nd and 3rd decades of life. 2. Among 65 cases, 43 were corrosive esophagitis or benign stricture of the esophagus due to caustic agents, 7 were patients with esophageal cancer. and there were 5 cases of esophageal perforation developed after pneumonectomy or pleuropneumonectomy. 3. Causes of perforation are instrumental perforation in 45, acute corrosion in 7, pathologic perforation in 7, surgical trauma in 3, stab wound in 2 cases, and one spontaneous rupture of the esophagus. 4. Most frequent sites of esophageal perforation were upper and mid thoracic esophagus, and 8 were cases with cervical esophageal perforation. 5. Complications of esophageal perforation were mediastinitis in 42, empyema or pneumothorax in 35, esophagorespiratory fistula in 12, retroperitoneal fistula or abscess in 5,pneumoperitoneum in 3, and localized peritonitis in 1 case. 6. Cases with malignant esophagorespiratory fistula were only 3 in the series which is predominant cause of acquired esophagorespiratory fistula in Western countries. 7. Various therapeutic measures were applied with mortality rate of 27.7% in the series. 8. In usual cases early treatment gave better prognosis, and least mortality rate in cases with perforation in mid thoracic esophagus. 9. Main causes of death were respiratory complications,acute hemorrhage with asphyxia, and septic complications. 10. Esophageal perforation developed after pneumonectomy gave more difficult therapeutic problems which were solved in only 1 among 5 cases.

• Journal of Chest Surgery
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• v.9 no.1
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• pp.69-72
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• 1976

This is to report a case of bronchgenic cyst. While most of the bronchogenic cysts reported in the literature so far were located either in the lung parechym or in the mediastinum near the tracheal bifurcation or main bronchi. the cyst presenting in this study was originated in the wall of the esophagus and was reported to be very rare. The cystic tumor was found accidentally by X-ray fluoroscopic examination of the esophagus and stomach in the patient with gastric hemorrhage. X-ray study revealed that the cystic tumor was oval in shape and located in the left posterolateral wall of the esophagus in the thoracic lower third. Two surgical operations, gastrectomy for gastric hemorrhage and the resection of the cystic tumor, were carried out separately. Gastrectomy including the removal of prepyloric ulcer by the Billroth II type procedure was performed in regular fashion, and the cystic tumor was resected radically without any injury of the mucous membrane of the esophagus. The cyst removed appeared to be filled with mucinous material, and histological examination identified the tumor as a bronchogenic cyst with ciliated epithelial internal lining. Postperative course of the patient was uneventful.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1106-1109
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• 1998

Primary malignant melanoma of the esophagus(PMME) is an uncommon neoplasm. And the world literature reports only about 200 cases. A case of primary malignant melanoma of the esophagus is presented, and followed by review of the literature. In our patient, the walnut-sized melanoma was located at the midportion of esophagus and there were two small satellite lesions at the esophagogastric junction. The main mass was diagnosed as primary malignant melanoma histologically and immunohistologically. The tumor was curatively resected by the transthoracic subtotal esophagectomy and the 2 fields node dissection. Post- operative immunotherapy was performed but the tumor recurred 7 months later at the stomach.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.87-91
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• 2003

Currently gastrointestinal mesenchymal tumors are divided into three major categories: myogenic tumors(leiomyoma, leiomyosarcoma), neurogenic tumors (schwannomas) and neoplasms that belong to neither group, which are known by GIST(gastrointestinal stromal tumors). The stromal tumors are hetrogenous, so that they may show myogenic or neurogenic differentiation or both, or no differentiation at all in some patients. The best defining feature for GIST is their expression of KIT-protein(CD117). Leiomyomas are the most common mesenchymal tumor in esophagus. Esophageal GISTS are very rare in comparision to those of the stomach and intestine. Recently we experieneced one case of the esophageal GIST, so that we describe an esophageal GIST on immunohistochemical analysis. A 70 years old woman complained of dysphagia and nausea for 3 days. FGS showed a huge elevated lesion in lower esophagus 33cm distal to incisor, which was covered with normal mucosa. CT and UGI showed the intramural tumor of lower third of the esophagus. The distal esophagectomy and esophago-gastrostomy were performed. The tumor was located in lower third of esophagus and measured as $6{\times}3.7$cm in size. Immunohistochemically, it showed weakly positive CD117 and diffusely positive S-100. SMA, desmin, NES and chromogranin showed negative immune-reaction. The patient was followed for 15 month after operation. There was no recurrence.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.734-737
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• 2000

Background: McKeown first described two autopsy cases of esophageal small cell carcinoma (SMC) in 1952; about 230 cases have since been reported in the literature. Small cell carcinoma has been reported to account for 0.4% to 7.6% of all esophageal malignancies. SMC of the esophagus as regarded as having a poor prognosis with frequent systemic dissemination. Choice of treatment remains controversial. Material and Method: From August 1987 to December 1998, a review of the records and histologic sections of 8 patients with primary small cell carcinoma of the esophagus seen in 11 years was undertaken. Result: Small cell carcinoma of the esophagus constituted 1.5% of all esophageal cancers. The median age was 61.5 years(range from 42 to 71 years). Seven patients were male, tumor was mainly located in the middle and lower thirds(6 cases) of the esophagus. Pure SMC is 5 cases, and mixed SMC is 3 cases. Operative procedure were as follow: transthoracic esophagectomy with thoracic or cervical reconstructon in 7 patients, transhiated esophagectomy with cervical reconstruction in one. The operative death was none. Adjuvant chemotherapy was performed in 7 patients except one who had poor general condition. Recurrence was observed in 4 patients(mediastinal LN, abdominal LN, SCN, bone). The overall median survival was 15.9 months. Only one patient survived for more than 5 years. Conclusion: We considered that esophageal SMC should be regarded as a systemic disease, and multimodality treatment including chemotherapy should be used. Surgery may be offered in selected patients to manage local disease as part of a chemotherapy based treatment program.

• Journal of Chest Surgery
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• v.24 no.6
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• pp.590-594
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• 1991

We experienced a case of leiomyoma on proximal thoracic esophagus. The patient, a 42-year-old female, noted the insidious onset of dysphagia and chest discomfort for 6 months. Esophagogram showed a smooth filling defect in upper third of thoracic esophagus, T1-T4 level and esophagoscopy revealed a firm mobile mass about 6cm in length with normal overlying mucosa. The lesion was approached the Rt. posterolateral thoracotomy through 4th ICS and enucleated of tumor without difficulty. The patient`s hospital course was uncomplicated.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1063-1066
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• 1995

Though leiomyoma is the most common benign esophageal tumor, it is rare in the upper third of esophagus. Recently, we experienced two cases of esophageal leiomyoma in the upper third of esophagus. The patient were a 53 year old female and a 40 year old male. On esophagoscopy, masses were found at 20\ulcorner23 cm, 22\ulcorner26 cm from upper incisor with normal overlying mucosa. Enucleation was done through a right posterolateral thoracotomy without complications.