title: Selective approach to the treatment of oesophageal cancer.
abstract: Between September 1985 and December 1994, 322 patients with oesophageal cancer were treated. Of the 190 patients who underwent operation, 173 had an oesophageal resection; in 124 this was performed as an abdominothoracic resection and in 49 by the transhiatal approach. The assessment of radicality after histological examination revealed a curative (R0) resection in 121 patients (70 per cent) and a palliative (R1-R2) resection in 52 (30 per cent). Prognosis was correlated with the extent of mediastinal lymph node dissection. In 77 patients with stage pT1-3 pN0-1 pM0 the 5-year survival rate was 40 per cent after abdominothoracic resection with two-field lymph node dissection and zero after transhiatal resection (P = 0.01). The authors propose a differentiated surgical approach involving abdominothoracic resection with two-field lymph node dissection for patients with limited tumours (pT1-3 pN0-1 M0) if the operative risk is tolerable. Transhiatal resection appears to be effective only in patients with early tumours (Union Internacional Contra la Cancrum stage 0).
authors.affiliation: Department of General and Abdominal Surgery, University of Mainz, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Junginger
authors.forename: P
authors.initials: P
authors.lastname: Dutkowski
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis