title: Limited resection for carcinoma of the upper thoracic oesophagus is not a realistic option.
abstract: OBJECTIVE
  Due to its anatomical position, carcinoma of the proximal oesophagus results in early invasion of adjoining structures, often precluding (radical) resection. We performed a retrospective study to compare the potentially curative and palliative treatment results in patients with proximal (i.e. at or above the carina) vs distal oesophageal carcinoma.
  
  
  METHODS
  Over a 3-year period 30 patients with proximal and 145 patients with distal oesophageal cancer underwent surgery.
  
  
  RESULTS
  Microscopically radical resection was achieved in 11/30 patients (43%) with a proximal tumour and in 96/145 patients (66%) with a distal tumour (P=0.007). Three-year survival was 13.8%vs 44.3% respectively; localization was an independent prognostic factor. Recurrent upper aero-digestive tract symptoms developed in 38% of the patients with a proximal tumour and in 19% of the patients with distal carcinoma (P<0.05).
  
  
  CONCLUSIONS
  Carcinoma of the proximal oesophagus has a worse prognosis than more distal carcinomas. Definite cure is exceptional; many patients are ineffectively palliated. In patients with proximal oesophageal carcinoma surgery should not be performed outside clinical trials testing multimodality treatment.
authors.affiliation: Department of Surgery, Academic Medical Center at the University of Amsterdam, The Netherlands.
authors.forename: C G
authors.initials: CG
authors.lastname: Manshanden
authors.forename: J B
authors.initials: JB
authors.lastname: Hulscher
authors.forename: M
authors.initials: M
authors.lastname: Hovius
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: J J
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: H
authors.initials: H
authors.lastname: Obertop
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000033:anatomy & histology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D013909:Thorax