Surgery for Carcinoma of the Esophagus: The Case for Transhiatal Esophagectomy.

The long-term outlook for most patients with esophageal carcinoma remains poor, but surgery continues to provide excellent palliation and the best chance for cure. Careful preoperative staging and patient selection, combined with a well-performed operation, lead to low surgical morbidity and mortality with good functional results. The long-term survival of these patients continues to be determined by the advanced state of most of these tumors by the time they are recognized and treated. The advantages of preoperative chemotherapy and radiation remain unproved; however, several nonrandomized trials suggest a survival advantage in patients who show a complete response to preoperative adjuvant therapy.