Combined treatment approach in surgical management of carcinoma of the esophagus: a preliminary report.

Surgical management of squamous cell carcinoma of the esophagus continues to be a controversial area in thoracic surgery. In a series of 20 patients, 15 received preoperative chemotherapy with cis-platinum (cisplatin), 2 received cisplatin plus 5-fluorouracil, and 3 received cisplatin plus vinblastine sulfate. Eighteen patients underwent en bloc esophagogastrectomy and postoperative radiation therapy. All patients were staged preoperatively by thoracoabdominal computed axial tomographic scan, bone scan, bronchoscopy, esophagoscopy, and barium swallow. Patients with liver or bone metastasis were excluded. The majority of patients received preoperative enteral hyperalimentation. Eighteen of the 20 patients completed the study with a follow-up of 12 to 24 months. There was 1 operative death, and 3 patients were in the hospital for more than three weeks after operation before they were discharged. Fourteen of the 18 patients survived for a year, and 11 survived for 12 to 24 months. Substantial reduction in mucosal disease and tumor burden based on preoperative barium swallow and endoscopy was evident in 11 of 18 patients, but in no patient was the tumor completely eradicated by preoperative chemotherapy. Although follow-up is short, this treatment regimen involving a combined treatment offers hope in the palliation of this disease.