The Annals of Thoracic Surgery, Vol 26, 274-286, Copyright © 1978 by The Society of Thoracic Surgeons
Carcinoma of the esophagus
RA Cukingnan and JS Carey
Carcinoma of the esophagus continues to have a low 5-year cure rate despite
advances in radical surgery and super-voltage radiation. Neither patient
education nor newer diagnostic techniques have improved survival. The
reported operative mortality is 4 to 30% for esophagogastrostomy and 10 to
44% for colon interposition. Average survival time with surgery is 11 to
28 months and 5 to 11 months with irradiation. Local recurrence is high (33
to 76%) with irradiation. The reported 5-year survival rate with
preoperative irradiation followed by surgery is higher (14 to 25%). Recent
reports have concentrated on improving functional rehabilitation rather
than improving cure rates. Palliative surgery is more acceptable because of
lowered operative morbidity and mortality and the high complication rate
with radiation therapy for far advanced disease. New approaches of interest
include fundoplication added to esophagogastrostomy, substernal gastric
bypass with anastomosis in the neck, reversed gastric tube (Heimlich
operation), the addition of postoperative rather than preoperative
irradiation in patients with potentially curable lesions, the use of
preoperative hyperalimentation, and the potential application of
immunotherapy.
