From our experience in 16 patients with persistent chylothorax from fistulas of the thoracic duct or its tributaries, we conclude that no standard treatment is uniformly successful and multimodality therapy should be considered. In selected patients, an anastomosis between ectatic lymphatics or hyperplastic lymph nodes and an adjacent vein may be attempted. Chylothorax from "leakage" of the thoracic duct or its tributaries is rare. Rupture of the thoracic duct superior to the sixth thoracic vertebrae generally results in a left-sided chylothorax; below that level, injury usually results in a right-sided chylothorax. The etiology is heterogeneous and includes blunt trauma, penetrating wounds (1), iatrogenic operative injury and lymphatic obstructions due to congenital abnormalities, inflammatory processes or neoplasms. Based on our experience in 16 patients with persistent chylothorax from thoracic duct complex lesions, we review the available treatment options.

In this paper the Authors report their experience of Orringer operation in 12 patients with oesophageal cancer observed from 1978 to 1992, and stress the possibility to extend the indications to Akijama oesophagectomy without thoracotomy for the treatment of malignant tumors of the entire oesophagus.

The authors report their series of 7 adenocarcinomas of the hepatic hilum. Five patients with a stage IV tumor underwent palliative surgery while the remaining 2 patients underwent radical surgery. One patient died and 3 reported postoperative complications. Overall survival was 2 years and 6 months: these results can be considered satisfactory taking into account the advanced stage and the bad prognosis of this type of tumor. The aim of a better quality of life may represent a reasonable indication to surgery.