Analysis of surgical treatment for carcinoma situated in the cervical esophagus

Between 1960 and 1982, 64 operations were performed for carcinoma of the cervical esophagus including the cervicothoracic segment. Of these 64 patients, 12 underwent cervical esophagectomy and 52 had total esophagectomy. Visceral replacements were employed in 61 patients by the skin flap (3 cases), the intestine pedicle graft (10 cases), and the stomach tube (48 cases). The operative mortality rate associated with cervical esophagectomy was 33.3% and that with total esophagectomy was 5.8%. The 5-year survival rate for patients who had cervical esophagectomy was 16.7% and that for patients with total esophagectomy was 30.0%. A direct comparison of the surgical results of cervical and total esophagectomy should not be discussed at the same level, because the cervical esophagectomy operations were performed before 1967. However, the discussion of histologic examinations for removed lymph nodes and resected esophagus will be of value. Analysis of these histologic findings was performed aggressively and we obtained the following results. Total esophagectomy completely removes the intramural invasive cancer cells in the anal stump of resected esophagus, and then dissection of the intrathoracic, including cervical, lymph nodes is possible. In addition to these merits, stomach replacement for esophageal reconstruction has the advantage of the only anastomosis (pharyngogastrostomy) as compared with the other visceral replacements. For these reasons it may be recommended that total esophagectomy with stomach replacement is adequate for the treatment of the advanced carcinoma situated in the cervical esophagus.