Sub-total oesophagectomy with 2 field lymphadenectomy.

At present surgical resection provides the only prospect of long-term survival for oesophageal cancer. It is nevertheless still associated with significant risk although this has dramatically decreased over the last 2 decades. During the same time period, however, the cure rate of both squamous and adenocarcinoma of the oesophagus have failed to improve significantly. There is considerable evidence to suggest that early cancer of the oesophagus (primary tumour confined to the oesophageal wall without lymph node metastases) is associated with a much better prognosis than more advanced tumours. These patients have a good chance of cure with radical surgery. Sub-total oesophagectomy with 2 field lymph node dissection minimises the risk of anastomotic and loco-regional recurrence and improves survival. Nevertheless, the majority of patients will still die of their disease and genuine efforts must be made to determine if patients with a short survival time can be identified and spared unnecessarily aggressive attempts at cure and palliation.