Combined therapy of thoracic esophageal cancer

High rates of esophageal cancer in advanced stages and poor short- and long-term results with surgical treatment have led to the use of combined treatment regimens. There is, however, no unanimity as to the most effective preoperative therapy or the most effective therapeutic tactics. In combined therapy we are in favor of strict compliance with the sequence of abdominal exploration, radiotherapy, and finally surgery. A differentiated approach according to the resectability of the lesion should be maintained. With regard to metastatic spread, nodes located in the paracardiac area and lesser omentum must be regarded as regional for the thoracic esophagus. Thirty percent of patients with metastases to these nodes survive more than 5 years after combined therapy. Based on our extensive experience in combined therapy plus an analysis of the literature we have formulated the features that will indicate palliative surgery. Differentiation between types of operations serves to determine more accurately the prognosis and the planning of further therapeutic tactics. With palliative surgery adjuvant treatment must always be given.