[Therapeutic approach in cancer of the esophagus with special reference to its potential metastasis]

A long-term experience with dissemination of tumor of different parts of the esophagus was evaluated using the results of resected material examination and post-operative follow-up. Schemes of treatment for different degree of metastatic spread of esophageal cancer are discussed. Diagnostic laparatomy is recommended prior to surgery, radiation or combination treatment of tumor of the median or lower thirds of the esophagus; laparatomy should remove paracardial lymph nodes, nodes of the lesser omentum as well as retroperitoneal nodes located along the left gastric artery, those in the vicinity of the bifurcation of gastric artery and along the upper boundary of the pancreas. If retroperitoneal lymph nodes are involved, resection of the esophagus is useless and radiation treatment may be recommended as palliation only. Cases of metastases in paracardial lymph nodes or those of the lesser omentum should be provisionally referred to a group of candidates for surgery, while the actual expediency of surgical, radiation or combined treatment of such cases is subject to further evaluation, as more data accumulate. In cases of cancer of the lower third of the esophagus, revision and surgery (radiation) should be carried out in the mediastinal lymph nodes located along the esophagus up to the bifurcation of the trachea; when the median third is involved--along the entire thoracic part of the esophagus; in cases of cancer of the upper third--along the esophagus up to the bifurcation of the trachea, including the cervicosubclavicular lymph nodes.