Principles of radical oesophageal surgery

The standard procedure for cervical oesophageal carcinoma consists of partial pharyngectomy, laryngectomy with tracheostomy, resection of one thyroid lobe and complete oesophagectomy. For intrathoracic and abdominal carcinoma of the oesophagus, subtotal resection leaving a small cervical portion is sufficient. If the carcinoma has not exceeded the organ boundaries or is located below the tracheal bifurcation, the choice of resection either by transthoracic, transmediastinal or endoscopic methods is not critical with respect to the radical nature of the resection. In carcinoma located at or above the tracheal bifurcation a transthoracic approach is mandatory, but due to a significant hospital mortality and a low 5-year survival the question regarding valid indications for surgery remains open in most patients. With reference to the rules of radical surgery a "three-field" lymphadenectomy, which includes the resection of cervical, mediastinal and upper gastric lymph nodes, seems to be indispensable in all oesophageal carcinomas. Only some Japanese groups perform this procedure routinely or in selected cases. They report a positive correlation between the extent of lymph node dissection and the long-term survival. Since none of their studies is prospectively randomized, a certain bias could exist resulting in better results for extended lymphadenectomy. According to European experience, radical surgery of oesophageal carcinoma is more fiction than fact.