ALTHOUGH many of the great surgeons of the past century have repeatedly attacked the problem of resection of the esophagus, their limited success has been mainly with transcervical and transabdominal dissections. In 1938 Adams and Phemister1 reported the first successful transpleural and transdiaphragmatic resection with intrapleural esophagogastric anastomosis. This noteworthy accomplishment seems to have marked the turning point in surgery of the esophagus. Since then a number of surgeons in various clinics throughout the world have reported a series of successful resections with a remarkable fall in the associated morbidity and mortality.
A number of factors, including the preoperative preparation of the patient, improved anesthesiology, chemotherapy and better postoperative care, have contributed to a major degree to this success. Not the least important factor, however, has been the standardization of operative technic. The left transthoracic approach for lesions of the cardia of the stomach and lesions of the lower