Surgery of esophageal carcinoma

Abstract

The experience of surgical treatment in 1,874 patients with carcinoma of the esophagus seen at the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences, Beijing, People's Republic of China, between 1958 and 1982, is reported. Despite the prevalence of this malignancy in this part of China, only 3% of the patients in this series had stage I disease, while 80% of the patients had either stage III or stage IV disease with extraesophageal tumor invasion and regional or distant metastases. Of the entire series there was an overall resectability rate of 83.9%, being 77.6% between 1958 and 1969 and 89.0% between 1970 and 1982. Among the 1,572 resections of the entire series, there were 66 deaths within 30 days of operation, for a resection mortality rate of 4.2%, being 4.9% between 1958 and 1969 and 3.7% between 1970 and 1982. Anastomotic leakage occurred in 67 cases of the 1,572 resections, for an incidence of 4.3%. Of the 67 cases with anastomotic leaks, 38 recovered after intensive treatment; the remaining 29 died eventually of the complication, giving a death rate of 43.3%. Pathologic studies of the 1,572 specimens showed lymph node metastasis in 46.1% of the cases. It is obvious that practically all the unresectable cases showed more extensive lymph node involvement at operation, although fixation of the tumor with severe invasion to the surrounding organs usually constituted the chief cause of unresectability. The postresection long-term survivals as calculated by the number of resections at 5, 10, and 15 years were 30.2% (390/1293), 22.4% (196/876), and 18.9% (112/594), respectively. Over one-third, or 36.8%, of the 1,874 patients in the present series were treated with a combination therapy of preoperative irradiation and surgery. The results in the group of 408 selective patients and those in the group of 83 randomized patients with midthoracic esophageal carcinomas were gratifying. In the latter group there was a resectability rate of 95.2%, a resection mortality rate of 3.8%, an incidence of intrathoracic anastomotic leakage of 0%, and a 5-year survival rate of 45.5%, as compared to 89.6%, 4.3%, 1.7%, and 25%, respectively, in the control group treated by surgery alone. From these findings it is concluded that preoperative irradiation as an adjunct can promote both the immediate and long-term results of surgery for carcinoma of the esophagus. Recent advances in the surgical treatment of carcinoma of the esophagus may change the pessimistic philosophy for this malignancy.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical application of iodine-eluting stent in patients with advanced esophageal cancer

“…Since malignant esophageal cancer has no specific symptoms in its early stage, 60–80% of esophageal cancers are diagnosed at the middle or advanced stage of the disease (12). Surgery is not a viable option for these patients, but a metal stent may be used as a treatment option to relieve the dysphagia, thus improving the quality of life of the patient.…”

The role of intraluminal radiotherapy and concurrent 5‐fluorouracil infusion in the management of carcinoma esophagus: A pilot study

“…The treatment of choice in early stages of esophageal carcinoma is surgical resection [20]. Adjuvant treatment with or without preoperative or postoperative external beam radiation has improved survivals only marginally [21-231.…”

“…The results of treatment of carcinoma of the esophagus have remained poor, irrespective of the therapy used. The treatment of choice in early stages of esophageal carcinoma is surgical resection [20]. Adjuvant treatment with or without preoperative or postoperative external beam radiation has improved survivals only marginally [21-231. Radiation therapy is often used as a curative modality in surgically unresectable but still localized lesions.…”

Efficacy and safety of esophagectomy via left thoracic approach versus via right thoracic approach for middle and lower thoracic esophageal cancer: a multicenter randomized clinical trial (NST1501)

“…Surgical treatment or surgery-based multidisciplinary treatment is still the mainstream. Historically, most of the esophagectomies for middle and lower thoracic EC in China have been performed via left thoracotomy and the diaphragmatic incision (Sweet procedure) (2)(3)(4)(5). About 90% of EC patients continued to undergo esophagectomies through the left thoracic approach (LTA) until 2010 (3)(4)(5).…”