Carcinoma of the thoracic esophagus. Results of one-stage surgery (271 cases).

A group of 271 squamous carcinomas of the thoracic esophagus were studied. All of these patients underwent the same operation: one-stage esophagogastrectomy through a combined abdominal and right thoracic approach. Adenocarcinomas, tumors of the cardia and excisions through a left-sided thoracic approach were excluded. The resectability of these tumors has increased progressively and, at present, applies to 74 percent of operative cases. A majority of these excisons (73 percent) were only palliative. Operative mortality was 16.6 percent for the group as a whole. In the last 3 years this rate has fallen to 4.6 percent. Overall survival at 5 years was 9.3 percent (8.7 percent without recurrence). There was a marked difference between the 5 year survival rate after curative excision (28 percent) and after palliative excision (2.3 percent). Despite such poor results, palliative excision remains justified and offers the patient longer and more comfortable survival than any other type of treatment. Two-stage excision represents a longer, more complex and more grave procedure than one-stage esophagogastrectomy. The addition of postoperative radiotherapy with or without chemotherapy in the last 3 years had led to a marked improvement in survival.