Surgical treatment of esophageal carcinoma.

The view of surgical treatment of esophageal carcinoma is pessimistic. This is so because (1) most patients present late in the disease and are beyond the benefits of surgical therapy for cure, (2) resection is associated with a high operative mortality, and (3) the poor 5-year survival rates for surgical resection cited in the literature are poor, although these rates may include procedures done for palliation and not for survival. Early disease is potentially curable. With a better understanding of the biology of the tumor and with improved staging techniques, patients who are able to undergo an en bloc resection designed for cure according to the classic principles of surgical oncology are selected. Five-year survival rates for curative en bloc resections range from 40% to 50%. For patients unable to undergo a curative resection, esophagectomy with esophagogastrostomy offers the best palliation. Transhiatal esophagectomy performed through an abdominal and cervical incision is an appropriate palliative procedure for tumors located in the lower third and cervical portions of the esophagus. The standard esophagectomy using a right thoracotomy is the preferred technique for a palliative resection of tumors located in the upper and midthoracic esophagus. Unresectable tumors may be palliated by intubation and, in some specific situations, surgical bypass.