En bloc resection for neoplasms of the esophagus and cardia

The principles of en bloc resection for carcinoma can be adapted to neoplasms of the esophagus. The techniques of the operation are described. Among the 80 patients undergoing radical resection, there were nine (11%) hospital deaths within 30 days of operation. The actuarial survival rate was 24% at 3 years and 18% at 5 years. There have been no recurrences of cancer more than 3 years after operation. Results have been significantly worse among 12 patients receiving preoperative radiation therapy than in 68 in whom operation was the first treatment (1 year survival rates, 17% versus 60%). There have been no significant differences in results based upon cell type or tumor location, but patients with diseased lymph nodes or full-thickness wall penetration of the tumor had a significantly poorer survival at 2 years than patients without these determinants of prognosis. Radical en bloc resection for carcinoma of the esophagus can be performed with a mortality rate no greater than that from the less extensive standard esophagectomy. A few patients may become long-term survivors after this operation despite unfavorable prognostic factors. The operation provides improved pathological staging as a guide to prognosis and need for subsequent adjuvant therapy.