Radical and Palliative Surgery of the Carcinoma of the Esophagus

Abstract

Carcinoma of the esophagus is a squamous cell carcinoma in 90 % of cases and an adenocarcinoma in 10 %. It accounts for 50 % of esophageal diseases and 3 to 5 % of all malignant tumors. In 40 % of cases it is located in the middle third, in 40–45 % in the lower third and cardia, and in the remaining cases in the upper thoracic segment and in the cervical esophagus. Although the biological malignancy is relatively low, the clinical malignancy is high, due to delayed diagnosis and to the peculiar anatomic and topographic situation. For this reason radical surgery, which is conditioned by tumor site, ways of spread and the obstacles of mediastinal structures, is only possible in a restricted number of cases. The site determines the surgical approach, extent of resection, type and preparation of the plastic material and mode of insertion into the thorax. The stomach is an organ suitable for plastic repair whereas the jejunum and colon have some contraindications. The results of surgery in cases amenable to radical surgery are not unsatisfactory. Operative mortality has reached reasonable values in the past few years: 12 % for middle and high localizations, and 8 % for low localization in the author's experience. 5-year survival in cases of low localizations in 6 % in the examined cases and 15 % in the operated cases; in cases of middle localizations 2 % in the examined cases and 10 % in the operated cases. For the upper, supraaortic localizations no cases of survival are recorded in any surgical series. The longest survival in the author's series is 16 years for low localizations and 13 years for middle localizations. With regard to palliative treatment, simple choices should be made since the results are similar to those of major surgery. Complications may occur immediately, early or late; particular consideration is given to anastomotic fistulas and to reflux esophagitis.