[Surgical therapeutic problems of thoracic esophageal carcinoma with special reference to the postoperative recurrent...

The purpose of this study is to analyze an actual status of postoperative recurrences and to discuss some problems in surgical treatment of patients with thoracic esophageal carcinoma. One hundred and one (21.8%) of 464 patients who underwent an esophagectomy for thoracic esophageal carcinoma were selected for this investigation. They were classified into three groups depending on the initial recurrent type of the cancerous lesions. 1. Lymphogenic type, consisting of 47 cases (46.5%) with the recurrence of the carcinoma. The cervical and upper-mediastinal lymph nodes were favorite sites of lymphogenic recurrence. 2. Hematogenous type, 42 cases (41.6%) with organic recurrence. Of these, pulmonary lesions were encountered in 19 patients (45.2%) and bone in 11 (26.2%). 3. Disseminating type, 12 cases (11.9%) with cancerous dissemination. All patients had the recurrent lesions on the pleura except one patient who had on the peritoneum. One of the characteristic features in the carcinoma of the thoracic esophagus seems to be high incidence of lymphogenic and hematogenous recurrences. It should be, therefore, taken in consideration to perform a systematic radical lymphadenectomy and to devise an effective multidisciplinary treatment combined with surgery.