Carcinoma of the esophagus is a numerically important human cancer. There is a justifiable pessimism regarding the treatment, because the endresults have been discouraging. Surgically and statistically, the cure rate is poor. The postoperative mortality is considerable, and the morbidity is high. Radiotherapists claim palliative results only (9). LOW RATE OF CURE Of 64 cases studied in three years, Stranahan et al. 1) reported 1 patient alive. Ravitch et al. 2) stated in 1952 that there had been no five-year cures a t the John Hopkins Hospital. In fact, they expressed the opinion that the results of extirpation of carcinoma of the esophagus had been so discouraging as to seriously question the value of direct attack. Sweet (3) reported 1 five-year survival among 30 patients with restricted carcinoma of the mid-thoracic esophagus. He also reported a primary mortality of 12 per cent for carcinoma in the mid-thoracic area. Shedd et al. (4) a t Yale University School of Medicine performed 30 resections in 74 surgical explorations. The only 3 surviving patients, however, showed histologic evidence of adenocarcinomas which apparently arose a t the lower end of the esophagus and represented gastric neoplasia.Radiation therapy is admittedly only palliative for esophageal carcinoma. The most successful results have been reported from Copenhagen, Denmark, where Nielsen ( 5 ) used the rotatory eradication technique. His results are quoted by several authors, including Pack (6) who states that four fifths of Nielsen's patients had freedom from symptoms, and the majority of these were able to swallow until the fatal day. This is an extremely complimentary report, but the inquisitive must ask what type of food can be swallowed. Probably nothing more than food in a liquid state, and with difficulty during the period of treatment.At the risk of appearing pessimistic, the treatment for carcinoma of the esophagus, particularly in the mid-thoracic region, demands a consideration of good palliation. Surgery alone fails in most cases. Radiation alone fails to provide hope for the rare patient who might achieve the surgical cure. The cooperative efforts of both surgeon and radiologist meet the appeal for surgical exploration and radiological palliation.Surgical palliation, however, is not to be excluded, although the present surgical palliative techniques give varying results. Watson (7) commented on
