Early detection and surgical treatment of esophageal carcinoma

From 1960-1980, the technic of abrasive cytologic examination by means of a "balloon catheter" has been used to detect esophageal carcinoma in high-incidence areas with rates of positive diagnosis varying from 87.8% to 91.9%. An application of this technic in mass screenings has led to detection of a large number of very early cases of esophageal carcinoma, of which only about 50% showed positive X-ray findings and 75% showed positive endoscopic findings. Intraluminal staining with toluidine blue through a fiberoptic esophagoscope gave a positive biopsy in 83.9%. In a 16-year period from 1964 through 1979, 237 patients with Stage I esophageal carcinoma underwent surgery. The resectability rate was 100% and the operative mortality 2.5%. Pathologic study of the resected specimens showed carcinoma in situ in 84 cases (35.4%) and early infiltrative carcinoma confined to only the mucosa and submucosa in 153 cases (64.6%). The 5- and 10-year survival rates following resection were 85.9% and 55.6%, respectively. In surgery on 1,647 patients with more advanced carcinoma of the esophagus and who underwent surgery between 1958 and 1979, (resectability rate of 83.4% and a resection mortality of 4.1%), the p-TNM histopathological classification of these patients showed that 72.3% had Stage III and 8.8% had Stage IV diseases, with either extra-esophageal tumor invasion and/or regional lymph node involvements, or distant metastases. The 5-, 10- and 15-year survivals, as calculated by the number of resections were 30.3%, 21.2% and 16.2%, respectively. Analysis showed that prognosis was related to staging of the disease, the extent of tumor invasion, length of the lesion, and the presence or absence of nodal involvement.