Surgical therapy of oesophageal carcinoma

Within the last 10 years, deaths following surgery for esophageal cancer have been reduced by 50 percent. This improvement has been attributed to the use of antibiotics, parenteral nutrition or tube feeding, improvements in anesthesia and surgical techniques, and intensive care medicine. It is hoped that the long-term prognosis will improve with the use of extended surgery and adjuvant radiation or chemotherapy. In this article, the results of surgical therapy for esophageal cancer, as reported in 1201 published papers, are reviewed. It appears that chemotherapy and radiation therapy have not improved long-term survival. Of 100 patients first seen and diagnosed with esophageal cancer, only 56 will have cancer that can be surgically removed (resected). Ninety-eight percent of the authors reported that the esophagus was resected and replaced during one operative procedure; the type of surgery depended upon the location of the tumor. Postoperative complications will cause an average of seven deaths; 49 of the 56 operated patients will be discharged from the hospital. Of these, 27 will survive the first year, 12 will survive the second, and 10 will be alive five years after surgery. A possible key to a better outcome is early diagnosis. However, the incidence of this cancer is low and does not warrant wide-spread mass screening. Radiotherapy after surgery may provide some improvement in long-term survival, but further studies are necessary. There is no evidence that preoperative chemotherapy improves long-term prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)