Recent advances in the diagnosis and surgical treatment of patients with carcinoma of the esophagus.

Five hundred and eighty-five patients with carcinoma of the thoracic esophagus underwent resection of the esophagus in the surgical department in which we work since 1965. The postoperative 30 day mortality rate was 11.9 percent during the early period, from 1965 to 1974, whereas it has decreased to 1.3 percent in the period since 1985. The most common cause of mortality was pulmonary complications (45.8 percent). The five year survival rate of patients who underwent a curative resection between 1975 and 1984 was only 29.1 percent, whereas it has remarkably increased to 49.9 percent since 1985, at which time cervical thoracic and abdominal lymph node dissection began to be regularly performed. There were three patients with intraepithelial carcinoma and 17 with mucosal carcinoma, respectively; none of these patients died within five years postoperatively. However, the five year survival rate of 73 patients with submucosal carcinoma of the esophagus was only 52.6 percent. Thus, it is clear that the prognosis substantially worsens when carcinomatous invasion reaches the submucosal layer. From the results of this study, it can be concluded that a combination of early detection and resection of the esophagus with three field lymph node dissection offers the best chance for long term survival in patients with carcinoma of the esophagus.