TRANSHIATAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

The two main approaches currently used for surgical treatment of esoph ageal cancer are transhiatal esophagectomy (THE) and esophagectomy thr ough a right thoracotomy. Among technical variations of THE, wide open ing of the diaphragm with ample mediastinal exposure allows resection under direct view with acceptable postoperative morbidity and mortalit y rates. Transthoracic esophagectomy associated with extensive mediast inal lymphadenectomy, still offers the best chance of definitive cure in intermediate stages (stages II and III), but does not influence sur vival in advanced cases (stage IV). In early stages, the lymph node in vasion rate is negligible and may be treated by other techniques (THE or endoscopic mucosectomy). THE restores oral ingestion and avoids res piratory complications of thoracotomy, and consequently can be reserve d for early cases (mucosal or submucosal lesions) or for patients with poor clinical status. To improve results of surgical treatment, proto cols of associated radiochemotherapy are currently under research. (C) 1997 Wiley-Liss, Inc.