Surgical treatment of carcinoma of the oesophagus and cardia

Abstract

SUMMARYExperience in the management of a personal series of 837 cases of carcinoma of the oesophagus and cardia is described. It is evident from this that the subject is not a static one. Improvement is occurring and there are good reasons to expect this to continue. The aspects affected by this improvement include morbidity, mortality, the well-being of patients, and the long-term survival. Unfortunately, in the majority of cases, treatment is only palliative, but palliation is good and it relieves the patient of his main symptom-dysphagia.In view of the great benefits which good palliation provides, no treatment can be considered as satisfactory unless the relief of symptoms is of a high standard.It is maintained that too much emphasis has hitherto been placed on long-term survival, which is only possible in the minority of cases.Bearing all factors in mind a strong case can be made for the overall surgical plan in the management of growths affecting the middle and lower parts of the oesophagus. all demonstrate a similar theme. With determined effort and the experience which comes from handling these cases in large numbers, the growths can be removed with a low level of morbidity and a mortality which is not too oppressing. It is also clear that improvement is still continuing. Operative mortality varies from 5 to 30 per cent and late results range between 10 and 25 per cent of operative survivors still alive at 5 years after operation. It seems reasonable to conclude that unless the operative mortality can be brought down to approximately 10 per cent and unless morbidity is low there is a tendency for radiotherapy to be preferred to surgery.Several workers have attempted to improve longterm results by combining surgery with radiotherapy and reports of the outcome of such efforts have been appearing during the past 20 years (Cliffton and

Transthoracic extended total gastrectomy for malignant obstruction of the cardio-oesophageal junction

“…It is the adenocarcinoma which will be considered. Whatever the treatment, this type of carcinoma has a worse prognosis than a squamous cell one in a similar anatomical position (Ellis, 1964;Collis, 1971), and adenocarcinoma of the cardia has a worse prognosis than in other sites in the stomach (Hawley et al, 1970).…”

“…It is difficult to make a worth-while comparison of personal results of extended total gastrectomy and upper partial gastrectomy because of the inevitable case selection. It is equally difficult to explain the improved results from surgery for carcinoma of the cardia during the past 20 years, even when ample allowance is made for increased experience ; this point has also been discussed by Collis (1971) and McKeown (1972).…”

Radiation myelopathy.

“…Of the 185 patients with cancer of the oesophagus who received radiotherapy, four developed radiation myelopathy, a much lower incidence than the operative mortality (Sturdy, 1965;Collis, 1971). More than 30% of patients with cancers other than oesophageal received radiation to the spinal cord while being treated for head and neck tumours, lung cancers, testicular tumours, and lymphomas.…”

Survival following Surgical Treatment for Esophageal Cancer with Liver Metastases

“…In a patient population with unresectable primary esophageal tu mors, there was a 10% incidence of liver metastases [ 12]. Many authors did not mention the incidence of liver metastases at all and reported only the survival rates in relation to the size and site of the primary tumor [13][14][15][16][17][18], Those who did mention the incidence have generally considered their presence a contra-indication to resect ing the tumor [19][20][21][22], with two exceptions [23,24], The effect of liver metastases on the outcome of these pa tients, however, has not been previously analyzed.…”