! "#$%! !&! %'

(%)%"   %&*+!  $,-"!

             ! 

 
./  0
1 0

 2 3 4 5667
@@ -

"%&!$ @ /

$& @ 1

%!, @ =

 (%)%" @ --

 8'!$   '$", @ -F

!! @ @ .-

$!$ @ ./

$$, @ .=

!$!$ @ /F

!&!$ @ 0-

/ !"%-9 @ 0/

:!$ @ @ 0F
 A MIS PADRES Sr. Jacinto Mendoza Verastegui Sra. Eleodora Rojas Pastrana Por su eterno
apoyo y cariño

"#$ %&'(' ) 
*+' ',  " -
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

. "#$ %&'(' ) 
*+' ',  "
 "%&!$

"%&!$
DR. MANUEL HUAMAN GUERRERO
DR. FILOMENO JÁUREGUI FRANCIA

"#$ %&'(' ) 
*+' ',  " /
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

0 "#$ %&'(' ) 
*+' ',  "
 $&

$&
INTRODUCCIÓN: La técnica del tubo gástrico consiste en la realización de un tubo gástrico
iniciado por división del epiplón menor, movilización del estómago con ligadura de los vasos
coronarios estomáticos izquierdo y gastroepiploicos izquierdo, luego aplicación de un cartucho
de grapas en un ángulo de 60 grados al borde derecho del estomago y otra paralelo a 20 mm del
borde libre de la curvatura menor hacia el lado izquierdo del cardias. Este tubo gástrico a través
del hiato esofágico se asciende por vía mediastinal posterior hasta llegar a nivel del cuello donde
se realiza una anastomosis gástrico esofágico.
El objetivo del presente trabajo es demostrar la utilidad de la técnica del tubo gástrico como
alternativa quirúrgica en el reemplazo de esófago, y evaluar sus complicaciones postquirúrgicas.
MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo retrospectivo no
experimental. Se estudiaron 51 pacientes con cáncer de esófago, en quienes se le realizó la
técnica del tubo gástrico como reemplazo esofágico, en el Servicio de Esófago del Hospital
Edgardo Rebagliati Martins entre Enero de 1995 - Diciembre 2001. Se realizó un método de
trabajo retrospectivo de recolección y un análisis de tipo descriptivo univariante.
RESULTADOS Y DISCUSIÓN: Se encontró que el grupo etáreo más frecuente en que se
realizó el tubo gástrico fue el de 60-70 años con un 39.22%. Con predominio del grupo
masculino con 54.90% de los casos. El síntoma más frecuente fue la disfagia, que se encontró en
el 84.31% de los pacientes. La complicación postoperatoria inmediata más frecuente fueron los
problemas respiratorios con un 31.37% de los casos. Y la estancia hospitalaria más frecuente fue
entre 1-2 semanas con un 47.05% de los casos.
CONCLUSIONES: Se concluye que la utilización del tubo gástrico es una buena opción
quirúrgica para el reemplazo esofágico en el cáncer de esófago, pero que no hay una operación
reconstructiva adecuada para todos los pacientes, así la operación debe ser individualizada.

"#$ %&'(' ) 
*+' ',  " 1
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

2 "#$ %&'(' ) 
*+' ',  "
 %!,

%!,

 *3,*  '45# , ' $% 5*,6 ',  -7  ' ' ,'('

$(#,' % *',  0 7  ' $' $(#,'   (#'(89 '
5*, , ','  : ,#6  5*,*( '  .  1 8*' $% ,  ';
$'*(,6 #,$, , ' 1<=< >'   %  ,(8 '*(*,4$(* &?9
#35(*$,  (,*(,*( ' 8(&6 ' &? ,  $%  '' @/-<A-<<6<<
+&(,'  >B6 %  $3'  (,*(,*( ' ,*,4 ,  &*(4,  +(, 
,, *, , ;($  -/<A-<<6<<< +&(,'6  '(#, 3, % 35(*9
 *' ;* ' '*,*(9 '*(  5*' (',,' *$  '
 &*6 ;*'(8 (,#'  *+6 ,('$(,' % ($,' *,$(,' *,
+,#'6 & +(#(, ,  (,#'  &&(' *(,'9 ,'(%, '(,'
$(#,' @C (,*$,  &&((  '  *3,* '53#(*B 
*'(6 5(&'(' *3'(*6 (8* '53#(*6 ('('6 *'(6 '5#(('6 '45# 
D6 ',$  $$E(,',9
 **(,$ '*$'  ($( '  ( +('4#(* $3' 5*, 
*3,*  '45# @F<F17B % ' &(* #,$, ,  *( $(  '45#9
 $,? *,'(% , '5 $,, &(  ' #,$,
8,: , C *,', ' *(,'6   *(:*(4, , (5,' '#$,' 
'45#6 *$>'  ' *,'*,*(' ,(*(,' C *'  ,5$9

, $*+' >' ' *,'(4 ($'(&  **' +*(  '45#6 *$
(#$, *(4 *, ' *'' *,*''6 ' $, , *, '

"#$ %&'(' ) 
*+' ',  " =
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

*$(**(,'6  $( %  '*' '8(8,*( , '' *'' ' '*& 

*(# *$ $G G(*9
' , -H=- C D(+ ,4  '(&((   '**(4, $ % , -H== '
5*4  ($ , , *(, *, *3,*  '45# *8(*9
, -F-/6
,I (:4  ($ '5#*$ ,'$('(,  ,
*38' % ,($'  ;($,*(4,9
 (,(*(   *(# $, + '( ,$* , -F-/6 *, I ;(4
;('$,  '45# 3*(*9 ((,+ ((:4  8 ;9
, -F//6 % ,6 *(?, &(3,(*6 (:4  ($ '5#*$(
,'$('(, ;('  **(,$6 (:,  #+9
 8,($(,   ,''( ,C $((4  (:*(4,  
'5#*$( ,'3*(* &? 8('(4, (*6 %  '5#*$( ,'+( '(,
*$ #4  ' , $G  ' 9
, -F02 J(' % , > 'G' ,,6 (5,(,  '   $ 8(
%  *$ *+6 *$$, , -F2. *, *8(*$ % ,'$'(' 
* KJ,9
, -F=16 (,# % , '(,  G*,(*  &%'' #3'(* '&', 
'45# 3*(* ;*( *$ , $G  (*(4,  **(,$' '53#(*
(,*&'L * $% G$(*6  +('4(*$, 5($9 ' *($(,
5 8(' *$ , M'($N &%''  (8(  ('5#( '(,  ,*( $&((
'(  , *$ % ,'$'(' '53#(* (,3*(*9 ' '
(,*(' *$(**(,'  ' *($(, 5,  5'   ,'$'('
*8(* %  ('*(4,  '45# 3*(* ;*(6 (*$, ,  , 
' ('9
, -F=16 (,# (:  ($ '5#*$ ,'+( , , *(, &'
*, , #, +,( +( '(:, % , ,**(,$ '53#(* ,  *( ('9
, -FH06 ' $(:  (:  & #3'(* *$ $:  '45#9
#'(8$,6 ' G*,(*' +, 8( *6 % ' ' +, (,* '
'**(,' , &C (*' %  '**(4,   $*' ,'*4(* %
,  (#,4'(* $,  $6 *, , 5*(8( $($, *,5($9
 *(# + 8,(  '  ( $3' '4( ,  $(,  *3,*
'53#(*9  ;G'(' '  $? '*(4,   ('5#( % *,  * ' # ,
$% '8(8,*(9 , (6 ' ' *' '  ' ,5$' , C(,' '
*( +*  '**(4,6 ' +, , '(' % EL   ' *,'( C '8
#,' *' ;**(,'6  *(4, '(# ,  $%  ' , 5(, ((89
, ' 99 ' + *$& C , (#,4'(* *: *$&(, *, ,
**' C(O#(* $3' M#'(8N6 + ( (,*$,, ' ,(*'  &(( %
;(&((6 *(, ' ''  $( +'(( % $?, ' *(5' 
'8(8,*(9
, , (,8'(#*(4, '*(8  /-2 *(,' ' -F=< +' -FF/ '
*(4 ,  O($ G* , $,   '8(8,*( $(  ' 1 >'6 (&(&
H "#$ %&'(' ) 
*+' ',  "
 %!,

 , $? *,* C(O#(* % 'C(O#(*9

' 8,*' $3' ,&' (,*%,  *$&(   ,(*(4, ,  ,6 
(:*(4,   ,'$'(' ,  *6  ('$(,*(4,  '  +$(8' % 
$  &' ,C'  & :6  * ('$(,% ' *$(**(,'
'(('9
*$, ' (:, 0 ('  '5#*$'
-9 '5#*$  8 J('

P $ % *(4,   8'* @'4$#B9

P *$ *+  $8((:*(4, % '**(4,  '45#9
P ,'$'(' (,3*(*9

.9 '5#*$ (* , &C

P $ % *(4,   8'* @*,B9

P ;*(4, *&$(, *, '**(4, , &C  '45# 3*(*6 #,#('
$('(,'6 *,( '$3C(*6 &:6 ' *$ #,#(' **' % 3*(*'9

/9 '5#*$ 3*(* 

P $ % *(4,   8'* @'4$#B9

P ;*(4,  * % $8((:*(4,  '45#9
P '**(4,   *(4, (,,   *8*  $(  '*+ 3*(*9
P '   8'* ',9
P ,'$'(' *8(*9
P *$ *+  $8((:*(4, % '**(4,  '45#9

09 '5#*$ ,'+(

P $ % *(4,   8'* @'4$#B

P ;*(4,  * % $8((:*(4,  '45#
P '**(4, ,'+(
P ,'$'(' *8(*

' (,(**(,'   '5#*$ ,'+(

P 3,* '53#(*  *( '(6 $(  (,5(9

P $' '53#(*' &,(#,'9
P ','(' '53#(*'  (,#'(4, *'(*6 '5#(('9
P ' *'(6 5? #''5#(* *,9

' *,(,(**(,'   '5#*$ ,'+(

"#$ %&'(' ) 
*+' ',  " F
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

P ,8'(4, C&,C(  $9

P *(,' *, ,5$ $'3'(* (',
P ,8'(4, $  '*' %*,'  +,*(' ('5#(*' '8'  
  3& C&,C(9
P *(,$ '53#(* , ' E9

$ ' $,(5'4 ,($,6 ;(', 8(' G*,(*' C(O#(*'   '**(4,
'53#(*  $&(G, ;(' *,8'( , *,  (  4#,  $: 
'45# ;(9
#,' ' *,(:,  '  *, *$ $: '53#(*  ' 8
C  *' ' (5*( % $ $*+ ($ , (:6 C(, / ,'$'('
@. , &$,B6 % +% , $% (,*(,*(  5' ,'$4(*9  %%,'
' '(8 , %*' *' ( ,(,6 ' (5*(  ' '#$,' #'6 % C
' $&', *, 5*(( ' 8''9  $%  ' *,(:,  ((:*(4, 
'4$# *$ '&'(  '45#9  '*,' #3'(* (, &, 8(( 
((#*(4,6 $( ;( (,5,'6 *, , &, *(& % , ' ,'$'('9 
5' ,'$(* ' $% *, %%,6 $, *, *, % $, *, '$#9 
(,*(,*(  ,*'(' %  $( ' '(#,(5(*(8$, $% *,  *'(
*$   #''(9 Q,# ,*,4 '' '($('6  (# C #',9
'  #''( ' , ;*, G*,(*  *,'(*(4,  3,'( 'G'
  '5#*$6 *, , G;( *'( , ' ' *''9
 * C  '**(4, ,'+( (,  8,? 6 8(,  *$6
('$(,(  ('#  ' *$(**(,' *($,'6 ('$(,(  ($
(6 (:  ,'$'(' ,  *6 , ' 5 ' *$>  $,'
$(6 % # , $% $#, (&  $ %  $3''(' '#,'6
('$(,%, '  '(&((  *((8 ,  '9
 *, *$ '' '8,?'6 '(  '**(4, "*(#" ' , '# *$ &?
8('(4, (* ,  *$6 '&  , ' $'  *( $(6 % '& 
'( , ('$(,%, ' '(&(('  **(4,  , ' , ,*4#(*6  C(,'
#,,  '**(4, ", &C"  '45# % '' ((' #,#(,'L C '
*$>  $% *,?  5  ' C ,  4;9 % C ' 5 
$, $&(G, ' $9
, ' '(6 + (,8'(# '&  ((   G*,(*  & #3'(* *$
,(8 C(O#(* ,  $:  '45#6 , ' *(,' C ' (:4 ,
'5#*$   *3,*  '45#6 ,  8(*(  '45#  '(
# &#(( (,'9 ' *$ 8 ' *$(**(,' 'C(#(*'
(,$(' C ' ',, *, ' G*,(* C(O#(*9

-< "#$ %&'(' ) 

*+' ',  "
  (%)%"

 (%)%"

 **(4,  '$# +*(  * *$ , ''( '53#(* *(&(4 $(
**(4,  ' ;(,( '(*( % (C:  '  8'* '&$*'9
(, $&# ' 8(*(,'  ,$ #3'(*  ' *(,' &(  5*'
(,(8(' % G,(*'6 8  ,*'( , *(,' &,*'  ' 8(' (' 
,#(9  G*,(* *3'(* *,'('

 
 ;
,  *(, , *O&( ' %  *&:  +*(  *+6 ' ;(,
 *9  *$ C(O#(* &* '  $,& +'  &(' % +*( 5
+' ' ,' +$(;('9 ,  *8( &$(, ' , $(, , (,*('(4,
&$(, '$&((* ,  , $(6 ;,(, '  ;(5(' +' 
$&(#9

 '($ '(  '4$# ' *  +*  $: '53#(*9  '
 $ ' 8'* '( ;(' ;,' 5(&'(' *(*(: #3'(* % *$(, 
O* G(*  *$ '*   (,#'(4,  , *3'(*6  $ C '  

"#$ %&'(' ) 
*+' ',  " --
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

*,  ''((  '45#9

!'+, <#$%;
 $8((:  '4$# ' '**(,, ' 8'' *,( '$3(* (:C( %
#'((* (:C(6 '8, ' *' 8'*' #3'(* *+ %
#'((* *+9

 $ *, '8(  (4, $% % '  ' +*( &?6 ?' 
'4$#6  5*((  (,(5(**(4,  ' 8'' #'((*'6 C *,  
#   *8 $%9  '(# *('$,  ( #'((* *+
'  3 (, +'  $(   *8 $%  '4$#6 ,
' $(, ,, ,    '4$#  (8((G,' , $' $3'
C>' C ' ,'$', *,  ( #'((* (:C(9
 
 ;
 (:  &?  $('(, '( *, ,  $(  (5#$
'  G,(* ;(5(' +'  +( '53#(*6  C $( ('**(4, (? 
'45# *&$(, *, ($(: *  ?(  %

-. "#$ %&'(' ) 
*+' ',  "
  (%)%"

(,53(*('53#(*6 ' *$  ' #' #,#(,' - % . % %*,'  ,*

*(*9

,'  $8((:  '45# 3*(* %  '**(,  ;$ *8(*6 +% C

,  '#(  C  $ '3 *(:  '5(*(, ,  '5#6  $
C '  +*  '**(4, #3'(* '8,   *   *8 $%
 5, #3'(*9 ( ' *$    $8((: ($   '45# 3*(* %
'**(,  '45# *8(*6   $ ' , #, C ' C( ,
+$(#'*$ ;($  '*6  ' C , C '5(*(, ,#(
#3'(*  #  *9 , ' '* , ,**(,$  *( ('6 ,
' '**(,  '4$# +' +& *$   ('**(4, '53#(*9 ,(&
*, $*+ *  , '(,  '4$# ,  **(4, '*,, 
,? ,' C    ,(4, '5##3'(*9
**(,, +*( &?  , ,' $ *,  $, (:C(6 '
(,*  $, *+  8G'  +( (5#$3(* % ' $8((:, $(,
(8'(4, ' 1  -< *$ (,5('  '45# '*  $('(,9

 '5#*$ ,'$('(, ' +* , ('**(4, ,  , $(6 *, 

* 8  ' ' '($ &(, (* ,  '45#  , , ,  *8(
 ,( '(,  3& C&,C(6 , (* ,  #(4,   *(,9 ( 
 $('(, ' ,*, *$$( *,  $6 & ' ;( , &*I
*,  '45#6 ##, ,? 3*(* ,(  &(9  *($(, 
5*((' O, $3' *, %  8('* '('(6 '&  ,   
 $('(,9
, 8: C ' + 8  (8'(4,  '45# +'  ,(8   *(,6 '
(,(*(  ('**(4, *8(*9  : , (,*('(4, *8(* &(*   & ,(
"#$ %&'(' ) 
*+' ',  " -/
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

 $O'* ',*($'( (:C(6  1 *$  ,#(L ' (,*('(4, , #

$3' 3   '* '',9  (,*(,  $O'* *3,  * % '
3$(,' ,4(*' *8(*' 5,'L  $O'* ',*($'( % 
8(, * ' ', +*( 5 %  (,# %  3C +*( ,9  ,8(
,# *, '  (,(5(* % '  #9  8, (( $( (,5(  
( (( (,5(  '**(,' % (#'6  ' , ' ,*'( '($ ,
 ('**(4, *8(* &?9  ('**(4, ' 8  8G'   3$(,' ,4(*'
*8(*' 5,' (*$, +*( 3'6 +'  ,'(' 8&9 
, ,  3C %  '45# ' ' $(, ('**(4, *,9 , 8:
$8((:  '45# *8(*  ' ?(' %*,' ,  ' *(*,5,*(6 ' 
 *, , ,?  ,'9
**(,,  ,?  ,' +*( (&6 ' (8'(, *,   
'45# '( ,  $('(,6 $&(G, C $,,(,  ('**(4, ,  ,
$(6 '($ *, ' ' (*' *,  '45# ,  $$,9 , '
&?   #, '  $8((:  '45# 3*(* '( +'  ,(8 
 *(,9
 '45# $8((:6 C + '( '**(,   ,  4; % (, '
, ' ;$ *8(* , ,?  ,'6 ' ;  &?  8G' 
$('(, '( %  +( (5#$3(*9   '45# 3*(* %  '4$# '
**, '&   ,(  &$,  (:  & #3'(*9
  ;
 &(:*(4, #3'(* ' (,(*(  (8('(4,  (4, $,  01 *$ ;($
  '& , (',*(  - *$   (**(4,  ,  2< '&  9 
'#$, ('  ($ **+  #' ' (*  ,(8  *(' ,#(' ,
, 3,#  2< #'  & *+  '$#9  '(#(, *# ',
(*' ,    .< $$  & (&   *8 $, +*(  
(:C(  *('9

 ,  '  #' #3'(*' ' 5: *, ,' (,8(' *(' 
((, <<<  ,' '' *, ' ,# <<<9
 ',*(4,    ,#(   *8 $% * , M&N #3'(*
C ' *, 5*((   $('(, '( % $( '&* , ,'$'('
,  '45# *8(* %  5,9
 (4, $% ' '**(, , (,:'  3,# *   $,' . *$ &?

-0 "#$ %&'(' ) 
*+' ',  "
  (%)%"

  ( #'((* *+6  **('  C , ' '(, ' 8''
,  $8((:*(4, #3'(*9
, 8: '  (4, $%   $( (,5(   *8 $% 
'4$#6  *(?, **(, +*( &?  (4, (,' $,,6 *, ' $,
(,*(  3'6  5*((  (,(5(**(4,  ' $' #'((*'
(:C('   #    '(   *8 $%9 , ' , +% C
8( C ' '(,  &:9
, *,'*,*(6  (#$, #'*4(* $,, ' '**(, , ' (,:'
 3,# * **'  $3' ** '(&  '4$#6 '(, '(,9 , 8:
'  '4$#  (4, $%6 ' ' ,*(4,   *8 $, 
'4$#9  (,*(  (#$, #'+3(*6 $,  **(4,  , '(, 
( #3'(* *+9  ( *,( '$(* ' (8( , (,:' % ' (# %
 (4, ',   #    '(   *8 $, ' ' 
'4$#  $, '($(9  (,*(  (, C *&  ,(4, #''53#(* %
'   '45# *, , , ,'9
 #  $3;($  '4$# $8((: ' +* , $( $,(& 
K*+L *,  $,(&  K*+ ' +* &(,6   (, C ' 
'5(*(,$, $48( *$  # ' ' '(*(4, ,$ +' *'(  G,(*
;(5(' ,  , $(9
 '(  '4$# ,  $('(, '( ' #,, ' .  / *$ 
;,'(4, *53(* C G' '  8 $3' * % $3' (* ,  '45# *8(*
%  &$,9 ' ((#*(4, ',#,   '4$# $8((:6 ' *$ 
'(*(    #3'(*6 +* C  '4$# ' $3' 8,?' C ' '
' 4#,' C ' $,  ''((  '45#9 &(,  
'4$#6 ' *,(,O  ('**(4, '53#(*9
 *,(,*(4, ' (8( &(*$,  '45# *8(* *,    % ' ' ,
,? ,'  ;$ (' ,  * *, ' #'9 ' ,?  ,'
' ((:3 'G'  **(,  '45# '(9  (,* ,  (,*('(4,
*8(* +'  $('(, '( , C> *  #' '',( *, ,
(,: % *, ' ' (', ' ' (,'*(,' % 5(&' 8#' ('53#(*'
$,,'9 ' #' ' # *,  $,  *(?,   %, (,*( , 
$('(, (,5( '  (,*('(4, &$(,9
,  '5#*$
,'$('(, ' & +* , $,( , % *,(,   '(4, ',#,
(,(  8(  +(,'(4, ,# C  *(  *' 
':$(,  *:4,9
, 8: C  '45# (,3*(* ' + $8((: (&$, ,  '
;,'(4, ,  $('(, '(6 '  '*   +( *8(*   &$(, % 
,?  ,' C (, ' ' '  8G'  $('(,9
' ;$' *8(* % &$(,  ,?  ,' ,'$('(, '
*(, *, (,:' +$'3(*'6 ' ',  '45#  ,? % '  '* 
*$ C(O#(*L  ,? ' ? ,  $('(,9  (,*   $, % 
,&:  *(?, ,  +( '53#(* % $('(, '( +' C , 
(,*('(4, *8(* ' 8, '  * '9
 ' $ ' '# , O,
"#$ %&'(' ) 
*+' ',  " -1
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

$('(, *   *&(  '4$#9


  ;
 (*  & #'(* '&   ,(  4; % ' (,(5(*  3 
5, #3'(* C +&3  # $3' (&9 , ' '(( ' '  ;$
&$(,  ,?  ,' ,'$('(, *, ' ,' <<< % ' '
*('$,  '4$#   +( (5#$3(*  '( ,  $('(,
'( $(, , *$&(,*(4,  '8 **(4, *,  ;$ *8(* 
,?  ,' % (,*(4, '  (,*('(4, &$(,9  $,  '*,
 '4$# ' ,88(, , &'  '(*   & #3'(*6
$,  *, +(  '6 # ' ** , +(  ' , ' 
'(6  # '*, ?,  +(  '  8G'  $('(, '(9

 *  5, ,  (,*('(4, *8(* '  $ *, '8( % '  +*
$# ,  +(6 $(,' *, , $, (,*( ,  $('(, ' 
&$, '  $? *,(,$, +*( (&9  5, #3'(*6 C + '3 ,
 *6 & # &(, 3'  '45# *8(* '**(,9 ,  &$,6 
 & C ?' &?  +( '53#(*  (5#$9 , *,
'8(  '4$#  8G'  +(6 ' +* , 8(5(**(4, 5(,  **(' 
C  '4$# , ' + *(  (,*( ,  4;9  5, #3'(* C '3
,  +(  * ' '   ,'(' 8& *, ' ,' 
((, <<<9

'' ,' 5(?,  '4$# ,  *  C  ,'$'(' #''53#(*

*8(* C ' +3 'G' ,  '5(*( ,(  5, , C ,'9  C
 &$, , ' *,$(, *, &*(' (,'6 , ' (,(*(  ,'$'('

-2 "#$ %&'(' ) 
*+' ',  "
  (%)%"

*8(* +' 'G'  +& *  (,*('(4, &$(,  *$ % +&
;*(  *$ (9

  ;
,  '4$# ' : , * (,*('(4, 8(* @-91. *$B % ' *  , 
' ,#  '45# *8(* &(*$,6 ?,   ,( 
'45#   $,' - *$ $3' # C  '(9  ,'$'(' ' (8( ,
* *,'9

$:, ,  3(*   (,*('(4, #3'(* % ,  , $(   

'53#(* '(6 ' **, ''  3*( (#(*4(* % ' ' '#  '
*$' %*,'  $ C ' ,' C, ,   ,'$'('9 , *
*, '( ' **, 0  2 ,'6 $:, ,  , $( % *,(,,
+*( ' *''9  , 8(' ' ' *'  '45# %  '4$#
&(*$,6 ',  .  / $$  &  *   $*' %  0  1 $$ 
&  *  ' O,(*' $*'  ''6 '*(8$,9 ' ,' &, '
 (,8'  / $$9 ' ,'  $&' *,' '(' ' ,, '
5 +*( , % ' ' '' ' *,6 ;* ' ' ,'  '
;$'9 # ' **, ' ''  *, ,(6 $:, ' *
,  ' ;$' % 8,:, +*(  , $(6 ,, , % 
*,6 +*(, ' ,'  , % *, ' '' , 5$ '*,*(9
, '4 C '*(  '  * ,' 5(,'6 ' '#  (,8'(4, 
O($ '#$,   ,'$'(' **, ,'  $& $(5(*'
?'**6 **?'L 5,6 ,56 5,6 ,59
'' ', ' O,(*' '' ,'$4(*' *, ,' ,'    59

 ' $, ' $(,  ,'$'('9

"#$ %&'(' ) 
*+' ',  " -=
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

*   ,'$'(' *8(* ' **, . *$  ,?  ,' %  +(

*8(* ' *( *, ;( *, 8(' ,' ''  ' &'&(& , *
,9

-H "#$ %&'(' ) 
*+' ',  "
  8'!$   '$",

 8'!$   '$",

P
$'  ((   G*,(*  & #3'(* *$ ,(8 C(O#(* , 
$:  '45#9 ' , ;(', &?' ,(' ,  O '& 
((:*(4,  & #3'(* *$ $: '53#(*9
P 8 ' *$(**(,' 'C(O#(*' (,$('   G*,(*  & #3'(*
,  $: '53#(*9

"#$ %&'(' ) 
*+' ',  " -F
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

.< "#$ %&'(' ) 

*+' ',  "
 !!

!!

(  '(  (:4 , '( '*((8 '*(8

('>  ,8'(#*(4,  ;($,
'  '( ' '?' , '( 5, ' ' *(,' *, *3,* 
'45# (,8,(' *,  G*,(*  & #3'(* *$ $:  '45# , 
8(*(  '45#  '( # &#(( (,'6 ' ,  -FF1 +'

(*($&  .<<-9 ' *' 5, ,   1- *(,'9
' *(('  (,*'(4,

P *(,' *, (#,'(* ,$4#(*  *3,*  '45# (,8,(' *,

 G*,(*  & #3'(*  $: '53#(*9
P ('( *,(* *, ' *$'9
P *(,' *, &O$(, ,$ ,'   *(4,9

' *(('  ;*'(4,

P *(,' (,8,(' *, ' G*,(*' C(O#(*'  $: '53#(*9

P ('(' *,(*' *, ' (,*$'9

' *(,' '**(,' 5, (,8,(' ,  8(*(  '45#  '(

# &#(( (,'6 C ' , *,  5,*( ,*(,   C '
# '53#(*9

"#$ %&'(' ) 
*+' ',  " .-
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

# ($,  '> ' C ' ' *(,' 5, (,8,(' ' 
' *(?,' &(, ,,' , *(# '53#(*6 *$ ', 
9 , $3,
 % 
9 ($, R3#( ,*(6  * ,' $( ;*( *(('  *8
 ,(:?9
G*,(* % G  &? G '*(8  ***(4,9  '(#,4 ,
5(*+  ***(4,  ' , ' *,'(#,, ' #,' %  5((*(4,6
* *,(* @'(#,' % ',$'B6 *$(**(,' 'C(O#(*'6 ',*( +'((9
' '*5(*'   #  ''6 ***(4,  '  '  8
C ', , %*  ,8'(#*(4,   5(*(,  *(*(4,  '(
&#((   &*(4,  ,' %*  '('   , **' 
*+(8  +('(' *,(*'  '( &#((9
'G'   &*(4, 
%*6 8($' **'  (&  '  *(,'   ; ' ,O$'
 ' +('(' *,(*'  ' ' (,8,*(,' C(O#(*' *,  G*,(*  &
#3'(* (,8( , ' >'  -FF1.<<-9 '($, ' ,' 5*((4  **' 
* ,  ' +('(' *,(*'9
*'$(, % ,3('('  ' ,3('('  ( '*((8 ,(8(,9 
(,5$*(4, 5 &,(  ' ('(' ,(*'  *+(8  6 '(,
;$(,' '&  &'   5(*+  ***(4,  '9 '' ' 5,
*''6 &' % ,(:' $(, ' #$' (,5$3(*' (*'5 ;*
%  ' ,3('(' ''(*' ' ((:4  #$ ((,5 E'(4, 29

.. "#$ %&'(' ) 
*+' ',  "
 $!$

$!$

 & S - $'  ('(&*(4,  ' *(,' '#O, 6 % ' ,*,4 C 
$% *,?  *(,'6 /F9..76 ' ,*, , ' 2<=< >'  9 '
*,*( C  (,*(,*(  *3,*  '45# '3 , ' 1<=< >'  6 
C # *(4, *, ' ''9

/ = ; 3 
 
  >    / <?
  @ .  AAB566@

 / C 3 

 DE
F = 3 
3 0 DGF
T.< < <9<<
.</< < <9<<
/<0< < <9<<
0<1< < <9<<
1<2< -0 .=901
2<=< .< /F9..
U=< -= //9//
  1- -<<9<<

"#$ %&'(' ) 
*+' ',  " ./
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!


   
 

 
 
   


 

 & S . ,' $( &'8 C  $% *,?  *(,' ',

+$&' *, , 109F<79  *3,*  '45# ' $3' 5*, ,  '; $'*(,9

/ = 5; 3 
 
  >    / <?
  @ .  AAB566@

 / C 3
H

H = 3 
3 0 DGF
'*(, .H 109F<
$,(, ./ 019-<
  1- -<<9<<


   
 

 
 
   




,  & S / ,' $' C  ('5#( '  ',$ $3' 5*, C
',, ,'' *(,'6 ',,  H076 '#(   ('(' % 
,;(9  ('5#( '  ',$ (,*( ,  *3,*  '45#9

/ = 7; 3 
 
  >    / <?
  @ .  AAB566@

 / C 3
I 3  3

.0 "#$ %&'(' ) 
*+' ',  "
 $!$

<I = 3 

3 0 DGF

('5#( 0/ H09/-
(,5#( . /9F.
(  ' -- .-912
( -/ .190F
('(' .- 0-9.=
,;( -0 .=901


   
 

 
 
   

   
 

 & S 0 ,$ ' (5,' *$(**(,' 'C(#(*'6 , ' 8

,   -F *(,' *, *$(**(,' 'C(#(*' (,$('6 '(,  $3'
5*, ' &$' '((' *, , /-9/=7  ' *''6 '#(   5'
 ,'$'(' *, /9F.79

/ = J; 3 
 
  >    / <?
  @ .  AAB566
3  
3
BK 4 < 

3  
3
KH = 3 
3 0 DGF
&$' '((' -2 /-9/=
'  ,'$'(' . /9F.

('5, - -9F2
(, $(**(,' /. 2.9=1
  1- -<<9<<


 !  
 

 
 
   

"#$ %&'(' ) 
*+' ',  " .1
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

  
 " 

 ',*( +'(( 5 $3' 5*, , -. '$,'  $,,*( @ &
S 1B6 *, , *,?  0=9<179

/ = ; >    / <?

  @ .  AAB566 
  .
3 


  .
3  = 3 
3 0 DGF
T- '$, < <9<<
-. '$,' .0 0=9<1
./ '$,' -. ./91.
/0 '$,' -- .-912
U0 '$,' 0 =9H0
  1- -<<9<<


 # 
 $   "   
 
 

.2 "#$ %&'(' ) 
*+' ',  "
 $$,

$$,

 '**(4, '53#(* + ', , #, '5   *(?,6 '(, 

'**(4, (#'(8 C ' *$>  #, ,O$  5' +* *' G*'
3'6 ' * C +* , '5#*$  , "'  (,'&"9 ,
-FH< $ +(: , 8('(4,   ( $,( '  > -F2<  ' 5*+6
**, ' ''  H/6=H/ *3,*'  '45#9 , ' ,,*'6 4
, $( (  .F76 *,*%, C , " $3'  $( C
*C(  *($(, C(O#(* (: (,($, +% , "
 **(4,  (  '5#*$ ,   ;(,*( % 5,*( 
*(?,6 #5  $6  % *,(*(4, &(4#(*  ,5$ %6 $ O,
&(6   '(&((  C ,   *($(, &(,, (5,'
'(&(('  **(4,9
;(' *,',' ,  ( C  '5#*$ ,'+( ', *'
8,?' 5,   '5#*$ ,'3*(*   $(,  *3,* 
'45#  *( (,5(6  ' ,( $, $&($(9
 '5#*$ ,'+( '  C $3' ' ((: , ' *($(,'
&'*(8'6  ;(', *,8'(' , ,  *,*  C ' , *$ 
(,*(( ,*4#(*  (: , &, (,5,*$ $('(,L '(, $&#6 '
* C  ,4'(* , $3'   #G,'(' % '(  $ C  '
'*' '>'9 ' 8 ('$(,%  $&(( % $(6  ($ C(O#(*6
 ' +'((6 ' G(' +$3(*' %  (,*(,*(  5#' ,'$4(*'6
$3'  ' *  $'  *C( ,(8 %  #,(: ,(*' 

"#$ %&'(' ) 
*+' ',  " .=
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

'8(8,*( '($('  ' (,5$' *, ' *($(,'9

( &(, #,' ' '($, C  (,5*$ $('(, % *8(* (*
$?  '8(8,*( % 8(,  *((8L ' 5($, C  '**(4, (* ,
&C6 $*+ $3' $( ,  **'  ' (,5,'6 , + ,( #, **(4,
 **  '(( '& ' G*,(*' +&(' % 8* $% $&(( %
$(9
, , '(  $',?#6  .. *(,' , '(' % 6 ' *, '
G*,(*6  $( 5  1 7 % $3'   $(  G'' @20 7B , '5(,
*,*(' , ,   .= >'9
(,(, +   *,* C  /2 ,5$' *, $' ,  *( '(
-F6 $( =  (,5( -<6 *'(5(*' *$ 06 ' F 5*(, %  '8(8,*( 5
 -16H $''9
E(' ' $,*(,, C  $: '53#(* & ' *, '$#
*$ , 8:  , & #3'(*6 % C ' + &'8 C ' *$(**(,'
G*,(*' *3'(*' *$ ' 5'' % ','('   ,'$'(' *8(* ', $*+
$,' 5*,' % '8' *, '$#  C *,  & #3'(*6 % C  
8'* '&$*' ' $,,( *,  '4$#  $(,' C *,  &
#3'(* '  8'* ' (,$( ,  ,  #'9

 *  *,*' *'6  & #3'(* *(& ' *(**(4,  '
(' #'((* *+ %  #3'(* *+9  (  & #3'(*
('('(* 5 &' '& ,'  8'' ',#,'6 &,(' 
(#$'  '$# , % , '& '('  & , '9  *$&4 C
*,  ,'$'('  & #3'(* ' (:  '45# *8(* , 
*, *, , ($ *(**(4,  ' ' *('   ,#(   & #3'(*6
   8'* (,$ ,  & #3'(*  *$,'   
' 8'' *' #3'(*' %  ( #3'(* (:C(9  $,(*(4,6 ,'(4, %
',#$(,   *(4, '(  &  *$$  (# (,$ %
('#  ,'$'(' '5##3'(*9
( &(, ' *3'(* 5($ C  ''(*(4, *, *, ' *$>  , $%
,(*  5  '6 '( 4 , .0H $:' *, *,6 , (,*(,*( 
5  '  '4 079
(*+$ % D(; *$, '*(8$, .H/ '' '45##3'(*'
*8(*'6 *, -01 '' '45#*4,(*' *8(*'6 % , ,*,, (5,*('6
*, ./6/7 % .-6/7 '*(8$,9
((6 , , '( *(8 '*(8   6 , =F< *(,' ,
&'84 ,(,#, (5,*( ,  ,(*  5  ' , *(4,  4#, ((:
  $:9
$&(G, +% ('*'(4, , *,   8  '*,'  & #3'(*6 '( & '
$(',(*  ',9
#   '5#*$ ,'+(6 ' 8' ((:' *$,  
*,'**(4, ',  ', %  $('(, '(9 4(*$, ' 
,  8(' ,*4#(* %  ' ''  # :6 ' $? 8( 
.H "#$ %&'(' ) 
*+' ',  "
 $$,

$('(, '(6  ' 5*'  $((  ((*(4, '(  *+

$6 % 8,( C  *((8 (,8(  $:9 $ 8,?'  $('(,
'(6 ' * C ' ,  $3' *6 $((, ' , $: $?
8'*(:L $3' 53*(6 '  ,  4; ' $3' $( , '  '( C
,(L ' $ $,' ($6 , +% C *,'(  O,L C  ','
, ','(' '( ' (*(,' ', $' 53*('  (: % C 
#*(4, '( ' $?9
,    $: ' $('(, '( +% ' '(('6 , 
4#,  $:  ' *$($(6 *$$(, ' ((#*(4,6 '& 
8,' % 8 '  ' ('C$(  ,*'('6 *(  L ,  '6 '  ,(8 
+( (5#$3(*   C ' *,'? , $(   '**(4,  +(
(5#$3(*  ('$(,(  ('#  *$'(4,9
  *$'(4,6  5*'  ,(8  &,C( 5, (:C(6 *$
(, *$& D(,( % *&'   , *(, *, ,*'('
*(  '4$#6 % ,*, , $&'('   8, #'((* *+6 ?'
 ,*($   *$'(4,  &,C( (:C(9
,  8  $: ' ',6 ' ,*'( +&($, , ,#(
$%  $:6 %  $('$  C *$($(     $,&(
',6   C ' ' C $, ' 8 *,'?,  '**(4,  , '*
 $('$6   ($ *'( %  *8*9
, , &? '*(8 % (:6 V(, % (*+$( *$&, C '
*,?'  5  ' ', ' 8*' $%' *,    $: '
',6 *C( '  ,O$  ,' ,'$4(*'9
' ' (&%, ' (5,*(  C ' ,*'( , ,#( $% 
'*,  '4$# ',6  * *,(*(, ,  ((#*(4,
(',(,   5  '9
' ' $&(G, *$,(*, '' '($('6 *, , $% *,? 
5' ,  *,'**(4, ',9
,  &? '*(8 % (:6 D' % (J *$, '
''   *,'**(4, ', % $('(, '( ,  '5#*$
,'+(6 , *$&, (5,*(' '(#,(5(*(8' , *,  ' *$(**(,'
C(O#(*'6 ' , *$&( , ' *$(**(,' *('(('6 , ' ' 
',*( ,   % ,  $(6 C 5, $%' *,  *,'**(4, 5
',9
'' (5,*(' ,  5,*(4, '(( 5, '(#,(5(*(8'  ' .0 +' 
'(9
 ,(* ** ('$(,%4 '(#,(5(*(8$, ,  ,'*'  ' ($' /2
+' , ' *(,' *,'('  8G'  $('(, ,(6 % ' ('$(,*(4,
' 4 '&   , **(4, ,  ,(*  8$, '('4(*9
, , &? 8( '*(86 ('+( *$,(*4 '($(' ''6 *, ,
('$(,*(4,  1<7 , ' *$(**(,' '((' *,  8  $: '
$('(, '(9
"#$ %&'(' ) 
*+' ',  " .F
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

$' *,*(6   :  '' ''6 C &&$, ' $?6 ,
  5   '6 *$  ' *$(**(,' *('(('6  8
$('(, '( % C '($ C ' +% # , '**(4, *$ 
$6 ' *( , <6    **(4,  $: & '  $('(,
'(6 '&  , C' *(,' *, ('# 8 *('((
 '*,' ', C( .  / *$ $3'  '4$#6 $% ,(*  5
 ' ' C +% $,' (,*(,*(  5'6 $%' *$(**(,'
*(8'*' , *(,'  ('#6 $% (5(*  (: (*(,'
,'*4(*' ,  '( '( ', 8,$, ,*'('  $(
(( '(L , *$&(  $(',(* ' $3' *6  , $(
(( '(9 (J *$4 , 5$ ,$(: $&' 8'6
*,*%, C $&' G*,(*' (,, '' '($('9
, , '( ,$(: ' *,*% C ' $3' O( ? ,? *8(* C ,
,  *9 '' '($(' ,,  ,  * &8 +( ,  '(
,$(:9 #,' ' *$(,, ** '($ ,?' , $&'
*8(' '6 , ,  '5#*$ ,'3*(* *$  ,'+(6 % C
' 5*, *'(, C>' **(,'    $(',(* , 
('**(4, '53#(*9
, ,' '( 8$' ' *$(**(,' C(O#(*' (,$('6 $3' ,
+$' 8 ' *$(**(,' ' *$ ' ','('   ' 
,'$'('6 ,( ' ''  # :9 , 8' ' ' *$(**(,'
C 8(, ' *(,' , ' +'((:*(4, 'C(O#(*9
,*,$' C ' *$(**(,' 'C(O#(*' $3' 5*, ', '
&$' '((' *, , /-9/=79 ' 5, *''  &,C((' #6 $3' ,
,*,$' , *'  ,$4;9
' *$(**(,' '((' *,(,O, '(,  *' $3' 5*, 
$6 , *(,' C #,$, ', >''6 *, ,5$ &,*$,
8(6  $, ',('6 % C (*(,$, ', '$('  , *$
  ' (,,'  8(  *$6  (,**(4,   8,(*(4, 5(3*(* %
'('$(: '(6  ,#'( ( *,(,6 *G9
#,' ' $,*(,, C  ,$4; '  *$(**(4, $3' 5*,6 
 , C  *,'(' *$ , *$(**(4, +&(L (,# *$,(*
=<7  ,$4; (:C(  &(6 (,'('(, C , 8: (: 
'5#*$ % ,'  8  '4$#  $('(, '(6 & 'C('' 
8G'  +( (5#$3(* @, 5$ 8(' % ,B  (,$,(  
'#' C , ;(', '#'6 %  ' ' ** , 5$ (,$( , & 
,? 3*(*9
'('  #J '& 5*'  (**(4,  *$(**(4, '(( , 
'5#*$ ,'+(  *3,*  '45# $', C  ('$(,*(4,  
**( 8(6  *('(' +3(* %  '( $ 8,:6 ', 5*'
,4'(*'  ('#  ,$, '(L '' 5*' '3, 5*,$,
',' ,  &*(4,  ,' '(9

/< "#$ %&'(' ) 

*+' ',  "
 $$,

' *$(**(,' '((' #  '5#*$ *, % '(, *$ ',

$(8  *,8'(9 ,  '(  (,' ' *$&, , $% ,O$ 
*$(**(,' '((' , ' '**(,' *, *$9
 -1- *,
*$ 1- *$(**(,' $,' @/07B6 %  -0- '(, *$ .0
*$(**(,' $,' @-=7B6  T <6<- (5,*( C ' $,(, '(#,(5(*(8 , 
,3('(' $(8(L  T <6</ #  ?'  # '(( 8(6 6
*(:*(4,  $ % 4#,  $:9
I6 J % Q,#6 , , &? '*(86 *$, ' '**(,' *, % '(,
*$6 % , ,*,, (5,*(' '(#,(5(*(8' ,  *,? 
*$(**(,' '((' , $&' *($(,'9 (, $&#6 ', 
'**(4, ,'+(6 '&  , ,5$' *, ('#' *($,' $'
 'L *,  *  ' '($(  *,?  *$(**(,' , ' #6 '
*,*%4 C +% $,' ('# *($, ,  '**(4, ,'+( 
*(,' '($('9
W , *,   $(6 *$&, , *,? '(#,(5(*(8$, $, ,
' ,'+('6  *(,' *, ('# $, 9 D, % *+',6 , ,
,3('(' '*(86 *$, '5#*$ *, *$ @J('B 8''
'5#*$ '(, *$ *$&, $&(G, $% '(#,(5(*(8$, $,'
*$(**(,' *('((' *,  *($(, 5 '5#*$ '(,
*$ @T<6<<</B % *,'*(8$,  (5,*(  $( *$& ,
*, % '(, *$ 5  -17 8'' <7 @ T <6<.1BL % '' (5,*(' ', $3'
8(,'6 *, ' *,'(   (  ' *(,'6 '  *(4,
  X 5 $*+ $% , ' *(,' '*' '(, *$ @T<6<.1B6 % 
(5,*( ,  $( ?'3,  6 ' 88 , $3' '(#,(5(*(8 @T<6<<-B9
$&(G, '  (,G' $,*(, C  *,?  *(,' *,  U 216 5
'(#,(5(*(8$, $% , ' *(,' '*' '(, *$9

 ' '' '('6 * ',' *$, C  '5#*$ '(,
*$ ' *$>  $,' ('#' *('((' C  (: 
8G'  , *$6 % '  **(4, , *(,' *, ('#' *(8'*'
8' % >''9
,  &? (:  (&6 , C ' ', *, *$6 ,*,,
(5,*(' '(#,(5(*(8' , ' *$(**(,' '(('6 *, , $% ,O$
*,  ,'$'(' ' *8(* C *, ' 3*(*6 (5,*( ''(*$,
'(#,(5(*(8 @T<6<<-B9 ' ' (,, ' (5,*( 8(,*  , ('**(4,
C $3' ;,' ,#((,$,6 % $% $('$ *,*(6 5*'
$&' C 58*, ' *$(**(,' '(('9 Y(:3' ' ;(C ,
#, ' *,(**(,' , ' ''  ' (8'' &?'6  (*+  
$6 , ' '5#*$' '(, *$6 ' 8,?'  , (: ,
*$6 ' *,&,*, *, ' '8,?'  , $% ('**(4, C %
$% $ *,*(9
, '#, #  ' *$(**(,' 'C(O#(*' ' ,*,  5' 
,'$'(' *, , /9F=7  ' *(,' ' ,  '( &#(( *, &
#3'(*9

"#$ %&'(' ) 
*+' ',  " /-
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

 5' *8(* * *$ *$(**(4, 'C(O#(* *, , (,*(,*(  /

 117 ,  (6  C *,* *, ,'' ''9
' '  *$(**(4, $3' $(   *(?,6  '&(,'  C ' 
*',  #, $&($( ,  '(6 '(, ' (#  ('C$( 
& #3'(*  ' 5' ,  G*,(* C(O#(*9 (,#6 '> C 27  5 
' , .<F *(,'L $(,* $' , *,? '($( , , '(  /.
*(,'9 (*,: $' 0<7  5'  ' *, 227  '*(,'
',3,' % //7  8*(4,   $('(,(('9
 ,'$'(' *8(* + #, , (  ' &? 5*,*( 
*$(**(,'9 , , '(  H12 *(,' ' *,  G*,(* 
'5#*$ ,'+( *, ,'$'(' ,  *6 , , ($ C &*4 '
-F=2 +' -FF06 ' 58&' '' &,(' 8(, ' $6 ' , '
(,*(' *$(**(,' 5(#, ' (,5**(,' *8(*' %  +('*,*(
,'$4(*9
 (#   5' '  (&%  (8'' 5*' *$ ('C$( %
*,#'(4, 8,'   ,'$'('6  ',*(   '' % 8'*(:*(4,
5(*(,  '45#6 (','(4, (4(* &(  ' $8($(,'  #*(4, %
'(*(4,6 +(&$(,$(6 ',*(  *G' ,3'(*' ,  ,  '6
((*(4, 8(6 $'* #  '45#6 &'**(4, ('   ,'$'('6
+(,'(4, (, % '(6 % *,$(,*(4, &*(,9
'*+ '>4 8(' 5*' *'' @' *#(&' % 8(&'B  ' O($
*$(**(4, *' @ ,'5(*(,*( (  5,' #3'(*6 (,'5(*(,*( 8,'6
(','(4, #3'(*6 (,5**(,'B6 ('G$(*' @+(;(6 ,(*(4,B6 Y(O#(*' @'
(,*6 +(,'(4,B9
 +% ' C *$&, , $% *,?  5'  ' , 
* *$ +''% % ,('6 ,I(,' % ++(, % ('9
(,'6 *$, , 5$ '*(86 $&(G, ,*,4 (5,*('
'(#,(5(*(8' ,  5 ,'$4(* 3*(* %  *8(*6 --7 8'' .276  T
<6<<-9
,$6 , (,8,*(,' (:' $%$,  '(,'6 ,*,4 $%
*,?  '  ' , *6 -.627 @$,'6 , G*,(*' ,'+('  *,
*$B C , 4;6 27 @$*3,(*' , *($(,'  J('B9
, *$&(6 ' ' , '($(' '' , ' 5'  ' ,
* % 4;6 *$ 5, % (,# % K#%9 $ % Q,#6 , , &?
'*(8 ,C , ,$(:6 , ,*,, (5,*(' ,  *,? 
5'  ' , *  4;9 (, $&#6 &$' *( C , ' &? '
$,8 '*$'(4, #3'(* '( *, ', ,'#3'(* , -< '9
D, % *+',6 *$, '*(8$, ,'$'(' ,  * @'(,
*$B % ,  4;6 , ,*,, (5,*(' '(#,(5(*(8' , *,  ' 5'L
' +& , $% 5*,*(  ','(' ,  * @.-7 8'9 F7B ,C ,
''(*$, '(#,(5(*(89
(& % *&' , -FF.6 (:, , &? '*(8 % ,$(:6
/. "#$ %&'(' ) 
*+' ',  "
 $$,

 ,(: ' '' (,$(' % ?'  ' ,'$'(' ,  *  , 

4;6 , 2< ,5$' '  ' &?'  ' &?'6 ' *( ' *,
*$ *+9 $&, , $% 5*,*(  5'  ' , *6
*+ , /<6 C , 4;6 ' , /<6  ($(,, ' '&*,(*'6 @'(' , * %
, , 4;B6 &8(, '($( ,O$ , *,  #8 *,(* % $(6 ' %
'9
'' &?' *,5($, 8(' *'' , ($ # C '( , ' (,8'(#,
(4#(*$, ' ' ,'$'('6 , ' '*(&(' *,(*$,
$*+' 5'6 '&  , *L , '#, #6 '( &(, ' 5'  ' , 
* (,, $,' $( C , 4;6 ' ,'$'(' *8(*' , #, 
 $('(,((' %  $L , * #6 C ', $3' 5*,' ' 5' , *
'&  *,'(, ' '&*,(*'L % , * #6 ,(, '' ' $'6 
' $3' 5*,'6 *,'(, #&$, ' *($(,'6  ('#  $ '
'($( , $&' #5'9
3' 3 ,,*'  ' '(#,(5(**(4, *,(* % $( 5(,6 * 8(, C
 ' ,  * (, $3' '(&(('  59  +, $,*(, *$ 5*'
C , (',  ' 56 '&   '6  $% ,'(4,   C ' 8
'$(  '6 *$ '  ,*'( , 4#,  $: $3' #6 %
8(,*  ' $('$ +*+6 ,  ((#*(4,  $:9  '' C *$
 *C( '6 8(  ,'(4, ' **(4, 5,$,9 , , *
$8((:*(4,6  '4$# #  * '(, ,'(4,L '($ & +*' , *$
$,(&  K*+6 C $( C   C  ,(8  +( '53#(*9  
6  *,5**(4,  , & #3'(* '*+6 *, '**(4,   $%   
C> *86 +* C ' ,#( ' # *,'(&$,6 #,  * '(,
,'(4,9 (, $&# , * G'  5* ($( C ;(C ' 5'  '
,  *6 % C  (',*( , , ,'$'(' 3*(*  @*$ & +*'B
% *8(* ' ,'  ./ *$9
% ' C +*, +(,*(G , '  5,' #3'(*  #, '*
*8(*6 *$  5'*( 8&6 *$ $  '# C  ,'$'('
$,:* ,  *9
  $,6  5 ' $% && ' ,*, , 
$('(, '(6 % , ,  *6 *,  #8 *,'(#(,9
, '*   ((#*(4,  '4$#6  '  ' , 4#,  ;*,
8'*(:*(4,6  5*  $8((:*(4, % ,''(*(4,  *6 '($ ' *
*( #  ('C$( ( % 8,'9
 8:  +(8$( (, % '(   +(;( , ;(* #,' 
(*+' 5'9
(*+$ , D(;6 C ,(:, ' '(' 5,*''6 , , (,*(,*(
 $ , 5  ' *8(* ..6076 $ , 5  ' 3*(* 1.7
' ' , *(5' '($('  $(   5  ' 3*(*
  2<7 % *8(*6   .<76 *$  , ' 8('(4,   
&(&(#5 % (9
E(' '  3,#  $( '#O,  *($(,6  ' $3' 5*,'

"#$ %&'(' ) 
*+' ',  " //
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

' 5'' *8(*'6  *,?  $' ' '($( $( , ' ,'$'('
*8(*' 06.76 $( , ,'$'(' 3*(*' 16=79
D(,(6 $&(G, 4 *(5' '($('  $( 0<F ,'$'(' *8(*'
=. 5'  '6 $(  .26279 /F2 ,'$'(' 3*(*' /. 5'  '6
$(  .179
' & ,,' *$ C '( &(,  8,   5  ' , '
,'$'(' *8(*' ' *$>  $, $( C  $('$ 8, *,
'* ,  4;6  ' $3' 5*,  8, ,  *6  '(&((  $
*, , ,'$'(' ,  *  ,  4; ' '($(9
 8*(4, *,(*  *3, * '  ((#*(4,  & #3'(* '*,(
 *6 , ' 53*(6 '  $, +% *( (,##(*(4, 8,'6 '3 , *
*(,4(*6 % ' 8''  ; $,*(, , ', 8('(&'9
6 '(4  ((#*(4,  5,' #3'(* $(, , ;$  '
**  (*+ ,(8 % *$, *,  4&   ?  *(, *,'(,
* *,  '*(4,  ;#, '3   $,'6  ,*($  H0H176 
 $, '*,  '*6 +' #   *, (*+ '*(4,9  +, +*+ ,
/- &' #3'(*' , , ' 5 9
  6  *(**(4, 8,' ' $3' ','(&  5*' $*3,(*'6 *$ 
'(4,  4#, '*,(  ' *$'(,'L ' ' C & ,' '*(
*( , 8(  '(4,  $:  '*,  *6 '&  , 
'5#*$ ,'+(6 ,  C , ' +* ' '*,' &? 8('(4, (*9
V(, % (*+$( *$, , -FF/6 , , &? '*(8 % (:6 
,'$'(' *8(* , ,  ' ,'6 10 *(,' , , , % 1/ , ' ,'9
&'8, 5  ' , -< *(,'  * # @-F7 % -F7B6 ' *( '(,
,(,#, (5,*(9 ( &(, * , *,? $%   ' *(5' $,('6
(,*% ' ' 5'6 (,*' ' '(,$3(*'6 (#,'(*' (4#(*$,9 ,
' ' G*,(*'6 *$ % 8($'6 ' ''  +('*,*(' 5, '(' *, 
***(4,  $: 5 ',6 *$ *, $('(, '(  '
$,8  ,(*  5' '($( , *,   *,(  ,'  '9
D(,( % *&' , , -FF0 ' ''  , &? '*(8
(:  '' *8(*'6 , ' *,(, %  ,' '' , ,
,6 $,6 , ' #'  .- ,5$' * ,9 $&, , ' 5
@(4#(*B6 .6076 ,  #  '  ,' ''6 *,*%, C 
,'$'(' *,(, '  $G  **(4,9 $ 8$'6  ' '*'' '('
'*(8' %  : (:'6 * C , +% $%' (5,*('6 , *, 
,O$  ,'6  '( ' *,(,   ,' ''6 ' , ' O($ '( ',
$% *' ' *''6 % , ' 59
 '( $(*G,(*   # 5($4 C  (,*(,*(  5  '
* ( **(, "(*$, *$ '   &, *(  '
$,' $('  ' '$(&'&(&'"9
,  8('(4, &(&(#35(*  6 ' *$&4 C  ,O$  5'  '
5 $% *,  $(  ' $ 5 , &'&(&6 --7 , -9... *''6

/0 "#$ %&'(' ) 
*+' ',  "
 $$,

$(,' C ', ' &'&(&  *,?  5' 5 =7 , -9=/= *''9
(, $&# +(',  <7  5  ' , -<0 '' $,' *,
' @, ' *'6 ,' ''6  (,8'(4,B9
 *,*$' , ' '* &?' *,' *$, ' $(' 
'9
 ' '(' '*(8' $* *, '#( $%' (5,*('9
 '  ' $*3,(* *(*   ,'$'(' + $(( '*, 
*,?  5  '  *(5' $% &?'9 '  ;(*' C
*,5**(, , ' ',(:6 '($ (#6   *(6 &',
(,,(,  L  $&(G, &$' * C $,  ,O$ 
','(' '('9
D(,( (, C , & *,'?'  ' $*3,(* ,  *  8('
:,'9 -B ' ,*'( , $>4, '53#(* $'( #9 .B ' ($'(& (,*(
, ' $%  .1 $$  (3$9 /B  5,' #3'(* & ' ,, 
$(( 53*( (,**(4,9 0B  '*+ '*( , *$, % 3C (5(* 
$,(&9
3' 3   5$  (:  ' %  $( $6 *( ' (,*(('
*,*('  ' ' '' (#'(8' * 5*  ($( ($,*(  
5   ,'$'('9
 '6  ''6 & ' 5*$, *,(,,L  '#O, I(%$ %
+(', % Q(I(,'6 $'(' ,'  '  (#' $'( '6 *'
',#*(4,  ('C$(  ' ?(' ''9
% $' (6 *$ '+J( , -F1<6 C ", $(*' G*,(* '
$3' ($, C  (  '"9 W C6 *$ , $*+' ' '(*(,'6 
;(,*( &&$, +*  (5,*(9 +J'6 J % *,I%
O, *, ' ' *,(*(,' ', (' *(' '**(4, (6
*($(, *6 *(?, ;6 G*,(* $(*'6 *(' *'
;(' , *,?  *(,' , C  5  ' (# ' *9 *+' 
' *' ' + 8  '45# & ((#*(4,6 5  ''6 G&( * $'*
% (, ,#((,$,9
E(' ' *,(:,   $(,  ' 5''6  (#,'(* *:6 
,? #'(86  ,(*(4, , ,# %  *(4, , ' *''
'8'9 , $(' $G(*'6 ,  $%  ' *'' *  *( ',3,
  5' , ' -<.< 'L %  *(4, ' , *'' '**(,'9
,  5(,  #,(: , * ((#*(4,  & #3'(* , 
'5##''( % 8(  +('*,*( ,  ,(4, 8('*6 ' + ((: *,
5(**(  $&(:*(4, (  ' 8'' ('  '4$#6 ;* 
( #'((* *+9 #  5*  $ '  $( 
5? ',#, ,     ' 4#,9
 ((:*(4,  ',( 3' %   ,$ $( *(& '
*$&(' ,  5'(4, %   , '4$# % %%, 'G'  ' $8((:*(4,6  5(,
 8 ' '   '5#'(9

"#$ %&'(' ) 
*+' ',  " /1
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

 '5#*$ ($(* ,*'($,  8#*$ &(6 *,  * 

'4$# ,8 ' *$ $:6  *$>'  ','  
8**(4, $3'  *(' (*+' ','6  (','(4, #3'(* *,'*,6
 ?#  *%8, ,  **(4,   5  '9 (?,' 
$( ;(,*(6 +*, +(,*(G ,  *$'(4, #3'(* '(L ' 8
 C ' *,'? (: , ('(6 ($  (#(*'( , ' '
*,'**(,' *, '4$#9

J ,*,4 , '(#,(5(**(4, ''(* ,  (5,*(  5  '
*, +% , 8*($(, #3'(*  @ Z <6<01B9 *$' C ' ' ,
&? '*(8 % C  ,$ $%6 ', '5#*$' '(, *$6 '
*( *, , & #3'(*9
' $ &(6 ' $3' 3  ' *(4, *,  5  '6 Q,# , ,
&? '*(86 *$, -H *(,' *, ,? (4(* % 1H '(, G6 *$&4
, ' ($' , $3'  (,*(,*(  *$(**(,' ' ##(*(4, &((
@11617 8'' H627B ',$  $(,# @//6/7 8'' 26F7B ,$, 
'(*(4, @-26=7 8'' /607B % O* #3'(* @..6.7 8'' -6=7B9
(,' 5($ C  ('(  ($ , 8(, ' ',' 
8**(4,  '4$#9 W C , *$&(  *,5**(4,  , & #3'(* '*+ 
/ *$   #   *8 $% % 8'*(:   #'((* *+6
+* C  $: ' 8* 3($, % , ' ',, ' *$(**(,'
8(''9
I % Q,#6   *,(6 , , &? '*(8 % (: *$,
-<< *(,' *, ('( % -<< *(,' '(, ('(6 '  *$
@J(' $B % '4$# ,6 *$&, (5,*(' '(#,(5(*(8' , &'**(4,
(4(* '( -/ ,  # '(, ('(6 < ,  # *, ('(9
 , *$&, (5,*(' ,  *,?  5'  '9
* ,,*'6 C '( &(, , , ;('( $%' (5,*(' , *,  
5  '6 , ' *(,' , C ' +* ,? (4(*  ,6 *, ' ((: 
'4$# , *$ $: *,8, (: ('(  #O,  $G 
$,'6  ,? (4(*6  8( *$(**(,' '('6 *$ 
$'  O,(* &? (:  '*9
( &(, ,$' &(&(#5 &# , 58   ('(6  8*(4, 
,'' *(,'  '( &#((6 , ' C , ' &'84 , ,(,#,
,*(4, #3'(* ,  '(6 $' C  *,5**(4,  & #3'(* +*
(,,*'(  (:*(4,  *($(,'  8**(4,L ' ('$(,% ,,*' 
($ ( % ' ($(,  (:*(4,  , '6 C ,C , '
5*,$, $(8  *$(**(,'6 , '3 (&  ' $('$'9 ' '3
% , ' &?'  D$$, % *&' , $'$ C , , '(
 -<1 *(,'6 *$4 ' ''   8**(4, #3'(* , *(,' *,
''(*(4, *, '4$# , % *, & #3'(*6 &'8, , ,(* $% &? 
' ,  8**(4, , '' O($'6 (,*' $3' &? C , C' *(,' ,
' C ' (:4 ('(9
 ','('   ,'$'(' '45##'(* *8(* *,5(#  *' $3'
/2 "#$ %&'(' ) 
*+' ',  "
 $$,

*$O,  ('5#( '(6 ,(, , (,*(,*( , .F2179 ' (,*('
*'' ',  $('$  ' '*'   $,(*(4, C(O#(*6 
5(*(,*(   ((#*(4, ',#,  ' 4#,' ((:' %  *(*(:*(4,  ,
5'9 '' , ,*,$' ,(,#O, *'  ','('  ,'$'('6 '
8$' '$, ' *$(**(,' 'C(#(*' (,$('9  $(,
(,(*(   ','(' '  (*(4, ,'*(* ',, &,' '' , 
$%  *''9 ( , '  '8  ','('6 ,,*' ' *   *(#
C  *,'('( , , ,'$'(' @'**(4,   ,'$'('6 '&($(,
% ,'$'('B6 ' @'  (5(*(   5'B  '( @'**(4, ,#((,
  ,'$'(' *, ' ,'8'B9
, *,   ('5, 'C(O#(*6 ,*,$' ' - *'6 ',, 
-9F276 C  ' 8: 5 , ('5, $6 C *(  ' . '$,'9  + 8('
C *, ' 8(  ***(4,  *C( '  $ *,  '*
C'5#(* ,  ('**(4,  * 8(  >  ,8( (,#
*,6 C  ' , *$(**(4, 'C(#(* ''' C , '
$,(5(' +'  ( 'C(#(* *,  *(, $(:  ;($,
'(*(4, &(  >   5,*(4,  ' *' 8*' % ('5,*(4, ,$
 '5, '53#(* '(9   * ' *$(, ((: ' '  
'*(4,   ((' %  3C ,  *(4,   *(4, *8(*9
, *,   & ((#*(4, '53#(* +% &?' ;($,' C
*,(*, ' 5($*(4,9 ( &(, , +% #,' (' C #,  '45#
5,$,  C  '5#*$ '(, *$  ,'+( ' , *($(,
'#9 %, $'4 C   8'*   '&$*' '53#(* &(, ,
;*, ((#*(4,9 ' ' *& $3' *,  ;(,*( C(O#(*  ,
',# &,, *, ' '**(,  '45# , *, 'G (& , ,
;,'(4,  12 *$6 % *$ (* D(,(6 *, , (,8(, , 5  '
'53#(*6 , ,*,  '45# ,( ,*4(* ,( ('CG$(* *$  (&(  5 
(*+ *'9
, *,  ' ',#'6 '( &(,  ' , *'  (,8,*(4, 5*,6
, #, , $(, ,  $(9 , ' &?' C ,(:, '
*$(**(,'6  $%   ' 8*' '   ,5$' *, $'
8,:'6 (,8'(8'6 , ' C  ',# ,  $ '(6 ' *$
$&(G,  *$' , *8(' ' &(' 8($,9 ' &8( 
($,*(  , ** +$''('9
 *( , +$#(  '(,    8, :%#'  $$, 
('*  '45# 3*(*6   * ' *,'? ((: '' 5,' ,
 +( (5#$(*6 ' ' ?(' '5#(*' , ' (,(5(*' &? 8('(4,
(*9  ,    ('**(4, ' *(#6  ,(8   ('**(4, '&(*6 % '( '
' ', $,,(' (*' **,$,  '45#6  ',# '3 9 
',# (,(  8: ;* ' 1<<$9 ,,(,  ('**(4, *, 
'45# ,  ('**(4, $('(, '( $(,($(:  (,*(,*(  (,?(  3&
C&,C(6  * * , $,'  -7  ' *(,' &? '5#*$(
,'+(9

"#$ %&'(' ) 
*+' ',  " /=
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

% $' (6 *$ '+J( , -F1<6 C ", $(*' G*,(* '
$3' ($, C  (  '"9 W C6 *$ , $*+' ' '(*(,'6 
;(,*( &&$, +*  (5,*(9 +J'6 J % *,I%6 '(,
 5*   ;(,*( ,  '   *(# '53#(*6 5(,(, *$
*(?, *'(, C C (: '  $,' '**(,'  >6 % *(?,
5*,  C (: '('  $3' '**(,'  >6 *$&, , (5,*(
''(*$, '(#,(5(*(8 , $&' *, , $( $3'  , '
*(?,' *'(,' @ T <6<<-B9 ' ' *& $3' ,  +*+  C 
5*,*(  5  '6 % ' $,  $*3,(*6 ' $% ,  8('(,'
**(8' C , '  *,' $3' ($,'9 W ' ;(*   C
+$' ,*, , *,? &?  *$(**(,'6 ' '' *'' 
*(,' '  (:, ' *(?,' &(, ,,' , *(# '53#(*9
*$, , #  *(?,'  ,(8'(% 5 ('&# (* , (
 '
' +(( *+ % R$' I(*+ +, ' , ,8 G*,(* 
'5#*$(6 C '* *, '#(  '5# *, , *$&(,*(4,  '
$G' '*(*' % **'(*6 % +, $,*(, C $&(G, ' (,(*
 *(,' *, *3,*  '45#6 5*(, ' 8,?'   *(#
'*(*6  8 , +% , '( '& '' ''  # 9
 '#*(6 , , ,' '6 *$ , ' ' '(' **(,'6 
',*(  ,'  (,8'(4, ,'$ '  #6   C ' $,
($&&  **(4,  ' 5**(4, $(, *(#9
,  $%  ' *(,'6  *3,*  '45# ' , ,5$ '('G$(*
,  $$,  ' ',*(4, *,(*6   C ' $(, C( $3' , 
( '('G$(* C *(:9
' ''(*'  '&8( *, '5#*$ , &C % (,5,*$
$('(,6 , ', $?' C ,  '5#*$ '(, *$ ' , '
#,' '('9

'5,$, , +% , *(4,  *,'**(4, '53#(* ( 
' ' *(,'6   * ' *(,' &, ' (,(8((:'9

/H "#$ %&'(' ) 
*+' ',  "
 !$!$

!$!$

P  '5#' *, & #3'(* ' *$, C  *$ ' 8(9
P  , ,'$'(' ' ((:6 % ' '# ,  *9
P  ('5#( '  ',$ $3' 5*,9
P ' &$' '((' ', ' *$(**(,' '(' (,$(' $3'
5*,'9
P  '5#*$ '(, *$ ' *$>  $,' ('#'
*('((' C  (:  8G'  , *$6 % '  **(4,
, *(,' *, ('#' *(8'*' 8' % >''9
P  5'  ,'$'(' , * '  '#, *$(**(4, '(9
P (,#O, 4#, C ' ''*(&  *'  ',''  ' ?#' #3'(*' '
(,' ,  '45# %  '$#9
P ($ C ' +% # , '**(4, *$  $6  $?  
$: '  $('(, '(6 '&  , ' *(,' *, 8 ('#
*('((  >''9
P  8(  ,'(4, ,  ,'$'('6 5(?,  4#,  , '* *8(* *$
 5'*( 8&9
P ' ,'$'(' *8(*' ' *$>,  $% ,O$  5'  '6 C
*'(,, $, $(6 %  $% ,O$  *$(**(,' '(('9

"#$ %&'(' ) 
*+' ',  " /F
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

P (, (# ('#  $&((  ' , * C  ' , 4;9

P  ' ',4 ,*(4, #3'(* *, , ' (:4  ('9
P , $,' ;($,'6 ('$(,%  $&(( '(9
P  +% , *(4, *,'*(8 *  ' ' *(,'6 ' 
*(4, & ' (,(8((:9

0< "#$ %&'(' ) 

*+' ',  "
 !&!$

!&!$

P  $,( ;*'(8$,  *(4, *,  & #3'(*6 ' ' +

*$& C  (# ',#,  .<7 *,  & #3'(* '  8G' 
,  $(*'*4(*  *(' % ('6 C  5*' *, ,
$,(*(4,  **(4, ;*'(89
P
& '*,'?'  ' $*3,(* , *9
P ' *,'?&  (#  (,  *,* 3*(*6 '&  , '**(,'
 *3,*  *( $(9
P ' &?' &$(, % *8(* &, (:' , 5$ '*,*( % ,
'($3,6 '  ' O($ 5$6  O,(* &,5(*( '  ($  *' 
$%' *$(**(,'9
P ,$' (: , '( '& ' ''   G*,(*  & #3'(* 
# : *$  *$5 ($,( %  +&((*(4, '*( C  C(9
P #($' (: , '( *$(8 , ' (5,' G*,(*' C(O#(*' 
$: '53#(* $' , ,' '9

"#$ %&'(' ) 
*+' ',  " 0-
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

0. "#$ %&'(' ) 
*+' ',  "
 / !"%-9

/ !"%-9

Akiyama H. Esophageal anastomosis. Arch Surg 1973; 107: 512-4.

Banbury, M., Rice, T., Goldblum, J., Clark, S., Baker, M., Richter, J., Rybicki, L. &
Blackstone, E. (1999) Esophagectomy with gastric reconstruction for achalasia.
Journal Thoracic Cardiovascular Surgery 117, 1077-1085
Bardini R, Bonavina L, Asolati M, Narne S, Peracchia A. Surgical treatment of cervical
anastomotic leaks following esophageal reconstruction. Int Surg 1987; 72:163.
Bardini R, Asolati M, Ruol A, Bonavina L, Baseggio S, Perachia A. Anastomosis. World
J Surg 1994; 18:373-8.
Bartels H, Thorban S, Siewert JR. La reconstrucción anterior frente a la posterior tras la
esofagectomía transhiatal: un estudio controlado y aleatorizado. Br J Surg 1993; 80;
141-4.
Bolton JS, Oschner JL, Abdoh AA. Surgical management of esophageal cancer. A
decade of change. Ann Surg 1994; 219: 475-80.
Casson AG, Inculet R, Finley R. Volvulus of the intrathoracic stomach after total
esophagectomy. J Thorac Cardiovasc Surg 1990; 100: 633-4.
Collard, J., Tinton, N., Malasise, J., Romagnoli, R., Otte, J. & Kestens, P. (1995)
Esophageal Replacement: Gastric Tube or Whole Stomach?. The Annals of Thoracic
Surgery 60, 261-266.
Corsi, P.R., Kanashiro, E., Schiola A., Cretella C., Gagliardi D., (2000) Tratamento

"#$ %&'(' ) 
*+' ',  " 0/
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

cirúrgico das complicacoes da anastomose esófago-visceral cervical. Revista do

Colegio Brasileiro de Cirurgioes 27, 293-297
Chasseray VM, Kiroff GK, Buard JL, Launois B. Cervical or thoracic anastomosis for
esophagectomy for carcinoma. Surg Gynecol Obstet 1989; 169: 55-62.
Churchill ED, Sweet RH. Transthoracic resection of tumors of the esophagus and
stomach. Am J Surg 1942; 115: 897.
Liebermann-Meffert, D., Meier, R. & Siewert, R. (1992) Vascular Anatomy of the Gastric
Tube Used for Esophageal Reconstruction. The Annals of Thoracic Surgery 54,
1110-5.
Davis, E., Heitmiller, R.. (1996) Esophagectomy for Benign Disease: Trends in Surgical
Results and Management. The Annals of Thoracic Surgery 62, 369-372
Gonzales E., Gonzales I., García I. (1992) Resección esofágica por abordaje cérvico
abdominal sin toracotomía. Surgery Today 22, 517-522.
Gutschow, C., Collard, J., Romagnoli R., Michel J., Salizzoni, M. & Holscher A. (2001)
Bile exposure of the denervated stomach as an esophageal substitute. The Annals of
Thoracic Surgery 71, 1786-1791
Korst, R., Sukumar, M. & Burt, M. (1997) Atraumatic Gastric Transposition After
Transhiatal Esophagectomy. The Annals of Thoracic Surgery 64, 867-869
Matsuzaki, Y., Edagawa, M., Maeda, M., Shimuzu, T., Sekiya, R., Nakamura, K. &
Onitsuka, T. (1999) Beneficial effect of prostaglandin E1 on blood flow to the gastric
tube after esophagectomy. The Annals of Thoracic Surgery 67, 908-910
Petsikas D. & Shamji. (1996) Revascularization of the ischemic Gastric tube using the
left internal thoracic artery. The Annals of Thoraric Surgery 62, 568-570
Piacenza G., Bergalli L., Carriquiry L. (1987) Esofagectomía sin toracotomía en el
tratamiento del neoplasma de esófago. Cirugía Uruguay 57. 93-101
Young, M., Deschamps, C., Trastek, V., Allen, M., Miller, D., Schleck, C. & Pairolero, P.
(2000) Esophageal reconstruction for benign disease: early morbidity, mortality, and
functional results. The Annals of Thoracic Surgery 70, 1651-1655
Young, M., Deschamps, C., Trastek, V., Allen, M., Miller, D., Schleck, C. & Pairolero, P.
(2000) Esophageal reconstruction for benign disease: self-assessment of functional
outcome and quality of life. The Annals of Thoracic Surgery 70, 1799-1802
Orringer, M., Marshall, B. & Iannettoni, M. (2000) Eliminating the cervical
esophagogastric anastomotic leak with a side-to-side stapled anastomosis. Journal
Thoracic Cardiovascular Surgery 119: 277-288.
Nyhus, L. M. Mastery of Surgery (1ra. Edición) Boston. 1984 P.577-585.
Universidad Nacional Mayor de San Marcos (1999) Cirugía General Tomo I. 470-475.
Thorascoscopic and Laparoscopic Esophagectomy (2000) Hiran, F., Neil, A., Luketich
Journal Thoracic Cardiovascular Surgery July 12 (3): 195-200.
Hayashi, K., Ando N., Ozawa, S., Tsujizuka, K., Kitajima, M & Kaneko T. (1999) Gatric
tube-to-tracheal fistula closed with a latissimus dorsi myocutaneous flap. The Annals
of Thoraric Surgery 68, 561-562
Honkoop, P., Siersema, P., Tilanus, H., Stassen, L., Hop, W. & van Blankenstein, M.

00 "#$ %&'(' ) 
*+' ',  "
 / !"%-9

Benign anastomotic strictures after transhiatal esophagectomy and cervical

esophagogastrostomy: risk factors and mangement. Journal Thoracic Cardiovascular
Surgery 111, 1141-1148
Urschel JD. Esophagogastrostomy anastomosis leaks complicating esophagectomy:
Areview. American Journal of Surgery 1995;169:634-40.
Gemsenjager E, Guyen P, Weiflog HP, Staubli M. Esophageal surgery in the regional
hospital. Schweiz Rund Med Prax 1998;87(39):1241-7.
Seineldin S: Alzari D, Silvestri B. Reseccion del carcinoma esofágico con
exteriorización parietal. Revista Argentina de Cirugía 1997;721/2:33-7.
García A., Roque F., Cruz A. Reemplazo del esófago con segmentos pediculados de
yeyuno. 1998. Revista Cubana 37(1); 13-20.
Piacenza G, Bergalli L, Carriquiry L. Esofagectomía sin toracotomía en el tratamiento
del neoplasma de esófago. Cirugía Uruguay 1987; 57(2-3); 93-101.
Orringer M. Esofagectomía transhiatal sin toracotomía. In: Zuidema-Sahckelford.
Cirugía del aparato digestivo. 3ª ed. Buenos Aires: Panamericana, 1992.
Nagawa H, Kobori O, Muto T. Prediction of pulmonary complications after transthoracic
esophagectomy. British Journal of Surgery 1994; 81(6): 860-2.
Goldminc M, Maddern G, Le Prise E, Meunier B. Esophagectomy by a transhiatal
approach or thoractomy: a prospective randomized trial. British Journal of Surgery
1993; 80(3): 367-70.
Earlam R, Cunha-Melo JR. Esophageal squamous cell carcinoma: a critical review or
Surgery. Br J Surg 1980; 67: 381-90.
Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H. Surgical therapy of
oesophageal carcinoma. Br J Surg 1990; 77: 845-57.
Moorehead RJ, Wong J. Gangrene in esophageal substitutes after resection and
bypass procedures for carcinoma of the esophagus. Hepatogastroenterology 1990;
37: 364-7.
Peracchia A, Bardini R, Ruol A et al. Esophagovisceral anastomosis leak: a prospective
statistical study of predisposing factors. J Thorac Cardiovasc Surg 1988; 95: 685-91.
Lee Y, Fujita H, Yamana H, Kakegawa T. Factors affecting leakage following
esophageal anastomosis. Jpn J Surg 1994; 24: 24-9.
Hankins JR, Attar S, Coughliln TR et al. Carcinoma of the esophagus: a comparison of
the results of transhiatal versus transthoracic resection. Ann Thorac Surg 1989; 47:
700-5.
Shahian DM, Neptune WB, Ellis FH Jr, Watkins EJR. Transthoracic versus extrathoracic
esophagectomy: mortality, morbidity, and long term survival. Ann Thorac Surg 1986;
41: 237-46.
Tilanus HW, Hop WCJ, Langenhorst LAM, van Lanschot JJB. Esophagectomy with or
without toracotomy. Is there any difference? J Thorac Cardiovasc Surg 1993; 105:
898-903.
Putnam JB Jr, Suell DM, McMurtrey MJ, Ryan MB, Walsh GL, Natarajan G, et al.
Comparison of three techniques of esophagectomy within a residency training

"#$ %&'(' ) 
*+' ',  " 01
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

programs. Ann Thorac Surg 1994; 57: 319-25.

Goldfaden D, Orringer MB, Appelman HD, Kalish R. Adenocarcinoma of the distal
esophagus and gastric cardias: comparison of results of transhiatal esophagectomy
and thoracoabdominal esophagogastectomy. J Thorac Cardiovasc Surg 1986; 91:
242-7.
Keagy BA, Murray GF, Starek PJK, Battaglini JW, Lores ME, Wilcox BR.
Esophagogastrectomy as palliative treatment for esophageal carcinoma: results
obtainned in the setting of a thoracic surgry residency program. Ann Thorac Surg
1984; 38: 611-6.
Lam TCF, Fok M, Cheng SWK, Wong J. Anastomotic complications after
esophagectomy for cancer. A comparison of neck and chest anastomoses. J Thorac
Cardiovasc Surg 1992; 104: 395-400.
Ribet M, Debrueres B, Lecomte-Houcke M. Oesophagectomie pour cancer malpighien
évolué de l'oesophage thoracique. Anastomose oeso-gastrique au cou ou dans le
thorax? Résultats tardifs d'une étude prospective "aleatorisée". Ann Chir 1992; 46:
905-11.
Piñeyro A, Bergalli L, Piacenza G, Rodríguez JL, Misa C. La anastomosis
esofagogástrica cervical ¿protege de la mediastinitis? Cir Uruguay 1987; 57(2-3):
105-8.
Thomas DM, Langford RM, Russell RCG, LeQuesne LP. The anatomical basis for
gastric mobilization in total oesophagectomy. Br J Surg 1979; 66: 230-3.
Liebermann-Meffert DMI, Raschke M, Siewert JR. How well vascularized is a gastric
tube from the greater curvature? World Congress of the International Society for
Diseases of the Esophagus, 4th, (abstract). Chicago 1989.
Salo JA, Perhoniemi VJ, Heikkinen LO, Verkkala KA, Jarvinen AAJ. Pulse oximetry for
the assessment of gastric tube circulation in esophageal replacements. Am J Surg
1992; 163: 446-7.
Dewar L, Gelfand G, Finley RJ, Evans K, Inculet R, Nelems B. Factors affecting cervical
anastomotic leak and stricture formation following esophagogastrectomy and gastric
tube interposition. Am J Surg 1992; 163: 484-9.
Orringer MB, Sloan H. Esophaguectomy without toracotomy. J Thorac Cardiovasc Surg
1978; 76: 643-54.
Richelme H, Balllieux J. Le traitement des cancers de l'oesophage. Paris: Masson,
1986.
Patil PK, Patel SG, Mistry RC et al. Cancer of the esophagus: esophagogastric
anastomotic leak a retrospective study of predisposing factors. J Surg Oncol 1992;
49: 163-7.
Fok M, Law S, Stipa F, Cheng S, Wong J. A comparison of transhiatal and transthoracic
resection for oesophageal carcinoma. Endoscopy 1993; 25: 660-3.
Isolauri J, Markkula H, Autio Y. Colon interposition in the treatment of carcinoma of the
esophagus and gastric cardia. Ann Thorac Surg 1987; 43: 420.
Giuli R, Sancho-Garnier H. Diagnostic therapeutic and prognostic features of cancers of
the esophagus: results of the international prospective study conducted by the OESO

02 "#$ %&'(' ) 
*+' ',  "
 / !"%-9

group (790 patients). Surgery 1986; 99: 614.

Orringer MB, Sloan H. Subesternal gastric bypass of the excluded thoracic esophagus
for palliation of esophageal carcinoma. J Thorac Cardiovasc Surg 1975; 70: 836-51.
Zieren HU, Muller JM, Pichlmaier H. Prospective aleatorized study of one -or two- layer
anastomosis following oesophageal resection and cervical oesophagogastrostomy. Br
J Surg 1993; 80(5): 608-11.
Orringer MB, Marshall B, Stirling MC. Transhiatal esophagectomy for benign and
malignant disease. J Thorac Cardiovasc Surg 1993; 105: 265-77.
Nishi M, Hiramatsu Y, Hioki K, Htano T, Yamamoto M. Pulmonary complications after
subtotal oesophagectomy. Br J Surg 1988; 75: 527-30.
Gurtner GC, Robertson CS, Chung SCS, Li AKC. Esofagectomía realizada por dos
equipos quirúrgicos sincronizados. Br J Surg 1994; 81: 620-2.
Hayes N, Shaw IH, Raimes SA, Griffin SM. Comparación de la esofagectomía
convencional en dos tiempos de Lewis-Tanner con el abordaje sincrónico por dos
equipos. Br J Surg 1995; 82: 95-7.
Mathisen DJ, Grillo HC, Wilkins EWJr et al. Transthoracic esophagectomy: a safe
approach to carcinoma of the esophagus. Ann Thorac Surg 1988; 45: 137-43.
Wang LS, Huang MH, Huang SI, Chien KY. Gastric substitution for resectable
carcinoma of the esophagus: an analysis of 368 cases. Ann Thorac Surg 1992; 53:
289.
Wilson SE, Stone R, Scully M, Ozeran L, Benfield JR. Modern management of
anastomotic leaks after esophagotastrectomy. Am J Surg 1982; 144: 95.
Payne WS. The role of esophageal blood supply in esophageal leakage. In: Cancer de
esophagus. Paris: Maloine, 1984: 222-5.
Tam PC, Fok M, Wong J. Reexploration for complications after esophagectomy for
cancer. J Thorac Cardiovasc Surg 1989; 98: 1122-7.
Mathisen DJ, Grillo HC, Wilkins EW, Moncure AC, Hielgenberg AD. Transthorcic
oesophagectomy: a safe approach to the carcinoma of the esophagus. Ann Thorac
Surg 1988; 45: 137.
Hopkins RA, Alexander JC, Postlethwait RW. Stapled esophagogastric anastomosis.
Am J Surg 1984; 147: 283.
Donnelly RJ, Sastry MR, Wright CD. Oesophagogastrectomy using the end to end
anastomosis stapler: results of the first 100 patients. Thorax 1985; 40: 958.
West PN, Marbarger JP, Martz MN, Roper CL. Esophagogastrostomy with EEA stapler.
Ann Surg 1981; 193: 76-81.
Wong J, Cheung H, Lui R, Fan YW, Smith A, Siu KF. Esophagogastric anastomosis
aperformed with a stapler: the ocurrence of leakage and stricture. Surgery 1987; 101:
408-15.
Fekete F, Gayt B, Place S, Bornet P. 380 anastomoses oesophagiennes mechaniques:
techniques et resultats. Ann Chir 1986; 40: 641.
Wong J. Esophageal resection for cancer the rational of current practice. Am J Surg
1987;153: 18.

"#$ %&'(' ) 
*+' ',  " 0=
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

Muehrcke DD, Donnelly RJ. Complications after esophagogastrectomy using stapling

instruments. Ann Thorac Surg 1989; 48: 257-62.
Lam TCF, Fok M, Cheng SWK, Wong J. Anastomotic leackage following oesophageal
reconstruction using whole stomach or distal stomach. Gullet 1991; 1: 114.
Postlethwait RW, Deaton WR Jr, Bradshaw HH, Williarns RW. Esophageal
anastomosis: types and methods of suture. Surgery 1950; 28: 537.
Matthews HR, Powell DJ, McConkey CC. Effect of surgical experience on the results of
resection for oesophageal carcinoma Br J Surg 1986; 73: 621-3.
Lam KH, Sim STK, Wong J, Ong GB. Chylothorax following resection of the
oesophagus. Br J Surg 1979; 66: 105-9.
Wu, Ying-K'ai. Surgical treatment of carcinoma of the oesophagus and cardia of the
stomach. Chinese Med J 1955; 73: 181-6.
Skinner DB. En bloc resection for neoplasms of the esophagus and cardia. J Thorac
Cardiovasc Surg 1983; 85: 59-71.
Hankins JR, Miller JE, Attars SA, McLaughlin JS. Transhiatal oesophagectomy for
carcinoma of the oesophagus: Experience with 26 patients. Ann Thorac Surg 1987;
44: 123-7.

0H "#$ %&'(' ) 
*+' ',  "
 :!$

:!$

 .      

S 99999999999999999999999999999999999999999
 99999999999999999999999999999999999999999999

T.< >'
.</< >'
/<0< >'
0<1< >'
1<2< >'
2<=< >'
U=< >'
;
'*(, @ B
$,(, @ B
**(4,
99999999999999999999999999999999999999999999999999999999999999999

"#$ %&'(' ) 
*+' ',  " 0F
   ! "#$%! !&! %' (%)%"   %&*+!  $,-"!

,*,' C(O#(*'
99999999999999999999999999999999999999999999999999999999999999999
\ ! 

('5#(
(,5#(
(  '
&$ '((
('('
(
,;(
'99999999999999999999999999999999
\]

^ 
(#5
,$
$
,$
99999999999999999999999999999999999999999999999999999999999999999
'5#'*(
99999999999999999999999999999999999999999999999999999999999999999

(#,'(*   #
99999999999999999999999999999999999999999999999999999999999999999
*(:*(4,   # '53#(*
99999999999999999999999999999999999999999999999999999999999999999

(#,'(* +('4#(*
99999999999999999999999999999999999999999999999999999999999999999
   
Y(O#(*
99999999999999999999999999999999999999999999999999999999999999999
E ^
99999999999999999999999999999999999999999999999999999999999999999
99999999999999999999999999999999999999999999999999999999999999999
    Y ) 
'  ,'$'(' #''53#(* *8(*
$(**(,' '(('
1< "#$ %&'(' ) 
*+' ',  "
 :!$

('5,
,#
'
99999999999999999999999999999999999999999999999999999999999999999
',*( '((
99999999999999999999999999999999999999999999999999999999999999999

"#$ %&'(' ) 
*+' ',  " 1-