Clinical Study of the Optimal Extent of Resection for Thoracic Esophageal Carcinoma

Abstract

In order to determine the optimal extent of resection for thoracic esophageal carcinoma, a retrospective study was carried out on 1, 023 patients receiving resection between 1959 and 1995. Partial resection of the esophagus followed by intrathoracic anastomosis resulted in a higher incidence of recurrence in the residual esophagus than total resection of the intrathoracic esophagus with cervical anastomosis. Because minute foci of intramural metastasis or lymphovascular infiltration cannot be determined by any equipment for image diagnosis at present, total resection of the intrathoracic esophagus should be performed. Cervical lymph node metastases were observed when cancer invasion reached the submucosa in cases of upper or middle third cancer, and the muscularis propria in cases of lower third cancer. So in these cases 3-field lymph node dissection is recommended in principle. On the other hand carcinoma in situ or cancer limited within the lamina propria mucosa showed no lymph node metastasis or lymphovascular infiltration, so endoscopic mucosal resection or transhiatal esophagectomy without thoracotomy can be performed. In p-T4 cases, combined resection of the esophagus and the lung resulted in a high mortality rate and very poor prognosis. Radical surgery for p-T4 cases should be limited toresponders to neoadjuvant chemoradiotherapy.