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J Thorac Cardiovasc Surg 1997;114:690-691
© 1997 Mosby, Inc.
HISTORICAL PERSPECTIVES |
Carl Eggers, his lifelong associate at Lenox Hill, described Torek as a versatile general surgeon attracted to operations requiring technical skill, careful planning, and, where need be, practice on the cadaver. His unusual patience, deftness, and courage were of inestimable value in the treatment of cancer, and Eggers believed that Torek would be remembered principally for his radical cancer operations—bold procedures carried out with neatness and attention to detail.
It is easy to understand Torek's attraction to the surgical challenge of cancer of the thoracic esophagus, clearly seen in his brilliant account of the first successful resection for this disease, March 14, 1913. The patient was a 67-year-old woman with a squamous cell carcinoma of the esophagus just below the arch of the aorta. She not only survived the operation but lived without evidence of recurrence for thirteen years. Not until 1921 was another successful resection of a cancer of the intrathoracic esophagus performed—in this instance, an extrapleural esophagectomy reported by Howard Lilienthal of New York. His patient died a little over one year later of recurrent disease.
Torek's historic operation was carried out despite Sauerbruch's dictum that cancers in the mid-esophagus were inoperable: (1) They were inaccessible, (2) damage or division of both vagi caused instant death, and (3) closure of the upper stump of the esophagus was prohibitively dangerous. Torek elected a long posterolateral thoracotomy, dividing the necks of ribs seven through four. The vagi were carefully dissected free and, to his great relief, the patient's pulse remained steady. After a difficult dissection behind the arch of the aorta, the esophagus was lifted from its bed just above the diaphragm and freed well into the neck. It was then divided several inches below the tumor and the lower end turned in. The upper esophagus with its tumor was brought from behind the aorta out through an incision in the neck and divided proximal to the tumor. A fresh rim of esophagus was sutured to the edges of a separate anterolateral incision, which later served as the proximal end of a gastrostomy tube bridge to a previously constructed gastrostomy. General anesthesia by tracheal insufflation according to the Meltzer-Auer technique was administered by Carl Eggers. The total anesthesia time was 2 hours, 27 minutes. At the end of the operation a hot coffee, whisky, and strychnine enema was given to the patient.
The success of Torek's operation had one unusual dividend. At the meeting of the Surgical Section of the American Medical Association that year, Willy Meyer, Torek's associate at Lenox Hill, reported the case, giving clear credit to Torek. There was no discussion! A few days later on a Sunday morning walk with his son, Meyer spoke of his disappointment with this shocking lack of interest. "Herbert, we must have our little Society where these important problems can be freely and thoroughly discussed." Needless to say, Franz Torek was present three years later in Willy Meyer's office at the birth of the New York Association for Thoracic Surgery.
In 1921 when Lilienthal reported his first extrapleural esophagectomy he noted, rather testily, that neither Torek nor any of his advovates of the transpleural route had been able to save another of these unfortunate patients with esophageal cancer; indeed, some conservative surgeons thought that Torek's singular success was far from being a benefit to mankind. So elusive was success that Torek, in his presidential address to the AATS in 1927, could appropriately devote his entire time to a discussion of one patient who died four days after extrapleural esophagectomy. Not until antibiotics became available in the forties did esophagectomy achieve an acceptable operative risk.
Torek, though highly regarded by his surgical colleagues, was not given to prolific publication and arguably may be best known for his operation for undescended testicle. Among other contributions, in 1930 he did score a "first"—the report of the resection of a solitary intrathoracic metastatic adenocarcinoma two years after hysterectomy. Recognition judged by election to membership in the American Surgical Association was delayed until he was 67 years old, the year after he was president of the AATS.
Now, at the remove of seventy years, his professional image emerges as a soft-spoken, perhaps even shy, thoughtful, and cultivated individual. His surviving granddaughter speaks of his gentle manner; how he liked to tell children's stories and sing children's songs; how he dressed fastidiously—three piece suits with a gold watch and chain that he kept removing from his vest pocket to consult; how at Christmas family dinner he carved the turkey with excruciatingly slow, surgical precision and an air of quiet, unmistakable authority. He was an accomplished musician—piano and violin.
Franz Torek died in Vienna in the summer of 1938. He was returning with his wife from a vacation trip abroad taken in the hope of finding relief from a cardiac condition. He was 77.
J. Gordon Scannell, MD
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