[Differentiated surgical therapy of esophageal carcinoma]

Between September 1985 and December 1993 280 patients suffering from esophageal cancer underwent treatment at the department of general and abdominal surgery at the University of Mainz. Of the 167 patients operated, 152 patients had an esophageal resection performed in 113 cases as abdominothoracic resection and in 39 cases via the transmediastinal approach. 104 patients were curative resected (R0). Recurrence-free and total survival were correlated to the extent of the mediastinal lymph node dissection supposing comparable operative stress. The mean recurrence-free and the mean total survival after abdominothoracic resection with 2-field lymph node dissection were 42.4 months resp. 47.3 vs. 18.9 months resp. 25.2 months after transmediastinal resection (p = 0.015 and p = 0.035). We suggest a differentiated surgical approach concerning abdominothoracic resection with 2-field lymph node dissection for limited tumor size (pT1-3 pN0-1 M0), if the operative risk is tolerable. The transmediastinal resection appears to be only enough radical in cases with early tumor stages (UICC 0-I) and also is advantageous for risk patients with simultaneously more advanced tumor (palliative resection), because of the lower operative stress.