Measures for improving therapeutic results of esophageal carcinoma in stage III: preoperative radiotherapy.

Surgical therapeutic results of esophageal carcinoma stage III in 245 cases admitted to our hospital from 1966 to 1982 are reported in this paper. In this series, 171 cases were treated by surgery alone and 74 cases treated with a combination of preoperative radiotherapy and surgery. Of the entire group, 184 cases underwent gastroesophagostomy or colon interposition for esophageal reconstruction preceded by resection of the cancerous esophageal segment. The resectability rate was 75.1%, and the resection operative mortality rate was 7.1%. The 5- and 10-year survival rates were 30.0 and 25.8%, respectively. In the group of 171 cases treated by surgery alone, the resectability rate was 73.1% (125/171), and the resectability in the middle third esophageal carcinoma was only 64.7% (44/68), while in the group of 74 cases treated by combination treatment, the resectability increased to 79.7% (59/74) and the resectability in the middle third esophageal carcinoma increased to 79.3% (46/58). The 5-year survival rate in the combination-therapy group (60.1%) was 42.9% higher than that of the group treated by surgery alone (17.2%) (p less than 0.01). However, the differences in the rates of resection operative mortality and operative complications between these two groups were not significant. Therefore, we think that preoperative radiotherapy for esophageal carcinoma in stage III is an effective measure for improving resectability and survival rate.