[The choice of methods and the goals of surgical treatment of carcinoma of the esophagus].

The hitherto experience in treatment of patients with carcinoma of the oesophagus has shown that survival rates are considerably longer after resection than following the radiation therapy or palliative procedures. In our group of patients, a ratio of 16.-2:4.4 months was observed. Resection of the oesophagus with primary oesophagogastric anastomosis is the most simple method with one anastomosis only. This method was uniformly used in all our patients. Reconstruction with interposition of the colon is technically more demanding. We have utilized it in two cases only. Resection of the oesophagus and staged reconstruction are less troublesome for the patient and decrease the operative risk, but markedly prolong the entire therapeutic procedure. The technique employed in lesions involving the cardia and distal part of the oesophagus includes a left transthoracic and transdiaphragmatic approach. In higher oesophageal carcinoma, mobilization of the stomach is made through laparotomy and followed by a right transthoracic and, if need be, right transcervical resection of the oesophagus. The majority of surgeons share the view that resection of the oesophagus with a malignant lesion is potentially curative, but many of them, however, regard this procedure as affording exclusively palliation. In our series, the five-year survival rate was 21.7%. The treatment of choice should employ the simplest technique available for a radical resection and reconstruction in one stage, account for the lowest postoperative morbidity and mortality possible and afford a prompt relief of dysphagia. We also advocate a deliberate palliative resection for ist being the only palliative procedure which markedly increases the survival of patients.