CLINICO-PATHOLOGICAL STUDY AND SURGICAL MANAGEMENT OF ESOPHAGEAL CARCINOMAS

INTRODUCTION: Esophageal carcinoma is one of the most challenging problems confronting the surgeons. Majority of the patients present late. In developing countries like ours, chewing of tobacco leaves along with use of betel nuts and leaves also, in addition to smoking and alcoholism, have been implicated in the development of esophageal carcinoma. Surgery is still the initial treatment of choice for a curative intent. Since the advancement of investigations, we can now detect these cancers at an early stage thereby improving the long term relief following surgery. MATERIALS AND METHODS: This study was conducted in patients who underwent surgery for malignant esophageal tumours in the Departments of Surgery and Surgical Gastroenterology, from September 2009 to March 2011. All the patients who were diagnosed and operated for carcinoma esophagus were included in the study. Data collected was analyzed and studied for understanding the pattern of the incidence, disease presentation, age/sex distribution, etiological factors, clinicopathological characteristics, complications and outcome of surgery. RESULTS: A total of 30 patients were operated with M:F ratio 2:1. Carcinoma esophagus showed peak age incidence in the 5th-6th decade. More than 90% belonged to the poor socioeconomic class. Nearly 75-80% of patients were either smokers, alcoholics or were addicted to betel nut chewing. Dysphagia was the primary mode of presentation. Esophagogastroduodenoscopy was done in all patients. Lesions were predominantly seen in lower 1/3rd of the esophagus. Histopathologically, 22(73.3%) had squamous cell carcinoma while the remaining 8(26.7%) had adenocarcinoma. All 30 patients were operated and of these, 26(86.6%) patients underwent trans-hiatal esophagectomy and rest underwent thoraco-laparoscopic procedure. 1(3.3%) patient had splenic tear intra-operative for which splenectomy was performed. 4(13.3%) patients developed complications like minor cervical anastomosis leak in 2(6.6%) patients, pleural effusion 1(3.3%) and pneumonia 1(3.3%), which were managed conservatively. There were no stricture/stenosis of the anastomotic site and no deaths occurred in the postoperative period. CONCLUSION: Squamous cell carcinoma of the esophagus is seen more than adenocarcinoma. Tobacco use and alcohol consumption along with presence of preexisting esophageal conditions are strong risk factors for the development of the disease. Disease shows predominance to male and is more common in 5th-6th decade of life. Carcinoma of lower third of esophagus is more common. Surgical approaches do not alter the mortality or survival although duration of stay may be reduced.