Influence of transposed stomach on cardiac function in patients with resected esophageal cancer

Echocardiographic Features of Postesophagogastrectomy Intrathoracic Stomach Mimicking Intracardiac Mass

Under certain abnormal conditions, part or all of the stomach can migrate through the diaphragm into the thorax. These conditions include congenital defects in the diaphragm and traumatic rupture of the diaphragm (commonly resulting from automobile accidents). A more common cause of partial translocation of the stomach into the chest is a sliding hernia through the esophageal hiatus itself. Intrathoracic stomach can also be iatrogenic; in this article, the authors describe the echocardiographic findings of a patient in whom carcinoma of the esophageal-gastric junction was resected and the cut ends of the esophagus and stomach anastomosed by bringing the stomach up into the thorax.

[Complications of surgical resection of esophageal cancer]

Esophageal resection has undergone refinements over recent years, with improved outcomes. However, in-hospital mortality remains above 10% in developed countries and is below 5% in only a select group of hospitals. Morbidity remains high even in high-volume hospitals. We reviewed risk factors in esophageal resection. Pulmonary complications occur mainly in older patients and in those with pulmonary dysfunction, especially %FEV1 or hypoxia. Liver cirrhosis, squamous cell cancer, low patient volume, and cervical anastomoses also increase complication rates. Neoadjuvant chemoradiotherapy, which may be effective in squamous cell tumors, can also increase morbidity. The main cause of morbidity and mortality are pleuropulmonary complications. Also significant are anastomotic leak and esophageal conduit necrosis. A complex procedure such as esophageal resection is better served in specialized teams.