Background: Esophageal resections for early distal cancer may be performed as limited resections with jejunal interposition. For long, subtotal resection and cervical gastric pull-up has been the mainstay of reconstruction.
Patients and Methods: Between 2000 and 2004, 18 patients underwent limited resection of the distal esophagus and the cardia for early adenocarcinoma and were compared to 72 patients with subtotal esophagectomy.
Results: Subtotal and limited esophageal resections are depicted in the table. 10/72 subtotal and 2/18 limited resections displayed pN1 status (13.9 and 11.1%, respectively, p=1.00, Fisher's exact test) and the mean nodal surgical retrieval was 25 and 15 lymph nodes, respectively. At a median observation time of 38.9 and 31.1 months, 33/72 and 16/18 patients survived, respectively (p=0.050, Kaplan-Meier model, log-rank test). 9/72 subtotal esophagectomies were followed by anastomotic postoperative leak, whereas leak was not observed in the other group (chi-square p= 0.11). Perioperative deaths occurred exclusively in the subtotal esophagectomy group (4/72, 5.7%).
Conclusions: Limited resection is a less traumatizing alternative and might be equally effective in terms of local tumor control in patients with early cancer without nodal metastases.

P=0.030*	Resections:	subtotal	limited	Total No.
Histopathology:
Carcinoma only in endoscopical biopsy	No. (%)	7 (9.7%)	5 (27.8%)	12 (13.3%)
HGIEN	No. (%)	1 (1.4%)	2 (11.1%)	3 (3.3%)
pT1a	No. (%)	17 (23.6%)	3 (16.7%)	75 (22.2%)
pT1b	No. (%)	47 (65.3%)	8 (44.4%)	55 (61.1%)
Total No.	No. (%)	72 (100%)	18 (100%)	90 (100%)

Table: Histopathology and surgeries: HGIEN=high grade intraepithelial neoplasia. *chi-square test