Surgical therapy of oesophageal carcinoma

Abstract

During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.

Role of thromboxane and leukotriene B4 in patients with acute respiratory distress syndrome after oesophagectomy

“…Patients undergoing oesophageal resection for oesophageal carcinoma, however, are a homogenous group, with 1-3 of 10 patients developing ARDS. 7 They are usually aged 50-70 yr, the majority have a history of smoking and preoperative weight loss, they are suffering from the same underlying disease, and the duration and magnitude of the insult triggering ARDS (i.e. oesophageal resection) is uniform.…”

“…It occurs frequently after oesophageal resection 7 and requires prolonged intensive care treatment in patients with nutritional and respiratory compromise. Modern multimodal treatment strategies for oesophageal carcinoma, which include preoperative radio-chemotherapy, significantly increase long-term survival of oesophageal cancer patients.…”

“…In a meta-analysis of more than 60 000 patients undergoing oesophagectomy, 27% developed ARDS after transthoracic resection and 13% after transhiatal resection. 7 The following factors appear to increase the risk of postoperative ARDS in patients with oesophageal carcinoma: smoking and chronic obstructive pulmonary disease (COPD), transthoracic mobilization of the oesophagus with contusion of the lung during extensive surgery and postoperative (silent) aspiration. 8 Because of the heterogenity of sepsis or trauma patients, it is difficult to acquire comparable study populations for clinical studies of ARDS.…”

Phase II trial of docetaxel, cisplatin and fluorouracil followed by carboplatin and radiotherapy in locally advanced oesophageal cancer

“…Of those undergoing operation, between 55 and 80% will have a 'potentially' curative resection (Muller et al, 1990;Sagar et al, 1994), which is safe only in experienced hands (Siewert et al, 2001).…”

Self-expandable covered metallic esophageal stent impregnated with beta-emitting radionuclide: an experimental study in canine esophagus

“…In general, more than 50% of patients with esophageal cancer encounter swallowing difficulty due to malignant obstruction; therefore, palliative therapy, including surgical bypass, laser treatment, or metallic endoprosthesis, is cur-rently being conducted for the restoration of swallowing (8,9). Although palliative surgery is effective, it is limited by its relatively high mortality rates of 5% to 60% (10,11).…”