Esophageal resection for cancer: the rationale of current practice

The prospects for patients with esophageal cancer treated surgically have improved considerably in recent years. A larger proportion of unselected patients can undergo resection, which now carries an acceptably low mortality rate. Serious complications arising directly from technical failure are minimal but a reduction in the incidence of the most common cause of death, pulmonary infection, and ultimately respiratory failure is not imminent and will require a concerted effort of investigation and modification of treatment strategy to achieve this. Pathologic studies indicate that a subtotal esophagectomy is desirable for all squamous cancers and, if possible, a resection margin of 10 cm should be obtained. The esophagogastric anastomosis made by a circular stapler is a very safe one, although it is associated with a high incidence of anastomotic stricture. Survival rates of resected patients are encouraging. Half of these patients had potentially curative resections and the 3.5 year survival rate was 41.3 percent, whereas for those resected for palliation, it was 7.3 percent. Almost all patients had their ability to swallow restored, which was the primary objective of operation.