Our study provides an update of the incidence of oesophageal cancer in the West Midland region of England and Wales from 1992-96. A total of 2,671 cases of oesophageal cancer were identified during the 5-year study period, with an age-standardised annual incidence (ASR) of 5.24 per 100,000 (95% CI: 5.02, 5.45). Similar numbers of adenocarcinoma and squamous cell carcinoma were found. Only 152 (5.6%) had no histology. There was a 5-fold difference in age-standardised annual incidence rates between males and females for adenocarcinoma of oesophagus, but no gender difference for squamous cell carcinoma. The parallel but higher ASR in males compared to females for adenocarcinoma of both oesophagus and cardia merits further investigation. The similarities in the patterns of age-and sex-specific rates and in the socioeconomic profiles could indicate a common aetiology for adenocarcinoma of oesophagus and gastric cardia. Quality control in Cancer Registries needs to focus on the accuracy and consistency of subsite classification to ensure that trends in incidence are identified. In the absence of accurate subsite classification of stomach cancers, the proportions of adenocarcinoma and squamous cell carcinoma of oesophagus (or the absolute rate of adenocarcinoma of oesophagus) may provide a useful tool in indicating whether adenocarcinoma of gastric cardia is likely to be increasing in incidence.Key words: oesophageal cancer; oesophageal squamous cell carcinoma; oesophageal adenocarcinoma; gastric cardia adenocarcinoma; cancer incidenceThe reported incidence of carcinoma of the oesophagus has been rising steeply in the UK since around 1970, particularly in males. [1][2][3] There have also been reports of rises in other parts of Europe including Denmark 4,5 and Norway 6 as well as in the United States 7 and Australia. 8 Our study provides a reliable update of oesophageal cancer incidence in the West Midlands region of England up to 1996. It also compares squamous cell carcinoma of the oesophagus, adenocarcinoma of the oesophagus and gastric cardia with respect to incidence and socioeconomic deprivation. MATERIAL AND METHODSThe West Midlands region of England and Wales is broadly representative of the country as a whole, with a mix of rural communities and urban conurbations. The population has increased from 4.76 million in 1961, 5.11 in 1971 and 1981 to 5.30 million in 1991. The external boundary has remained the same but as a result of immigration, there has been a change in the ethnic make-up of the region. In the 1991 census, which was the first to include a question on ethnic group, the proportion of nonwhite residents was 8%, of these 37% were Indian, 24% were black, 23% were Pakistani and 10% were of other Asian origin. 9 For the 5-year period 1992-96, a retrospective audit was undertaken of all patients with a reported diagnosis of cancer of oesophagus or gastric cardia. 10 Patients with diagnoses ICD-O C15, C16.0, D00.1 and D00.2 were identified from hospital discharge coding or by local Medical Records Departme...

In this unselected population-based series there was little evidence of a trend of improving 30-day mortality rate with increasing workload, or between workload and long-term survival.

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It is not widely recognized that duodenal contents are implicated in the causation of severe reflux oesophagitis and stricture formation in patients with hiatus hernia. In a randomized prospective trial, including only patients with severe oesophageal changes, standard Nissen fundoplication has been compared with antrectomy and Roux-en-Y reconstruction. Twenty-two patients were randomized to each group. The 42 surviving trial patients have been followed for an average period of over 5 years. Good results (Visick I or II) have been achieved in 91 per cent of 22 patients having antrectomy and Roux-en-Y anastomosis (Group B), compared with 65 per cent of 20 patients surviving after Nissen fundoplication (Group A). Poor results (Visick III or IV) seen in seven patients (35 per cent) in group A were almost all associated with failure of fundoplication to stop reflux. Two of these patients have subsequently had antrectomy and Roux-en-Y reconstruction with excellent results. Antrectomy with Roux-en-Y gastrojejunostomy appears to be superior to a standard anti-reflux procedure as primary surgical treatment in these patients. The technique is recommended: where the patient has a fixed irreducible hiatus hernia; where previous surgery at the hiatus has failed and rendered reoperation hazardous.