Surgical treatment of carcinoma of the proximal esophagus.
BACKGROUND
Proximal esophageal cancer is usually diagnosed at an advanced stage, and the treatment is often limited to palliation. Surgery offers the best relief of dysphagia but it remains controversial, because a cure is unlikely even at the price of laryngeal mutilation.


METHODS
We treated 40 patients with transhiatal esophagectomy for cancer of the proximal esophagus. The esophageal substitute was a stomach tube in 37 patients and colon in 3 patients. The larynx was preserved in 27 patients whose tumors did not extend to cricopharyngeus. Adjuvant treatment consisted of postoperative radiotherapy for 22 patients, chemotherapy for 1 patient, and a multimodality regimen for 4 patients.


RESULTS
The postoperative complication and hospital mortality rates with gastric tube transpositions were 22% and 8%, respectively, with a 3% fistula rate. The 1- and 3-year overall survival rate was 53% and 21%, respectively. The unfavorable prognostic factors were tumor wall penetration, lymph nodal involvement, and cricopharyngeal involvement. Local recurrence of cancer was the major cause of failure.


CONCLUSIONS
These results indicate that transhiatal esophagectomy with gastric tube transposition offers good palliation of dysphagia with low morbidity and mortality for proximal esophageal cancer. The laryngeal preservation can be attempted for tumors located close to, but not involving, the cricopharyngeus in order to retain speech in patients with a limited life expectancy.
Marmuse
J P
JP
Department of Surgery, Hôpital Bichat-Claude Bernard, Paris, France.
Koka
V N
VN
Guedon
C
C
Benhamou
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003106:Colon / Q000637:transplantation; D003131:Combined Modality Therapy; D004937:Esophageal Fistula / Q000209:etiology; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007830:Larynx / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D013270:Stomach / Q000637:transplantation