Usually, carcinoma of the upper third of the oesophagus presents at too late a stage for operative intervention. Radiotherapy is the therapy of choice. When the lesion is deemed to be operable, a total oesophagectomy is carried out.
The stomach and thoracic oesophagus are first mobilised via a laparotomy and an incision in the bed of the fifth rib. Then, the cervical oesophagus is exposed via an approach anterior to sternomastoid on the right. The oesophagus and stomach are pulled upwards from this point, removed, and a careful anastomosis performed between the remaining remnants.
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