Current Results of Esophageal Cancer Surgery. Time Trends in Operative Mortality and Long Term Survival

The Effect of Endoscopy on Patients with Malignant Esophageal Cancer after Medical Treatment and Chemotherapy

The esophagus is one of the most commonly used parts in a person’s life, and its importance is self-evident. With the unhealthy food diet, people are more and more likely to suffer from esophageal cancer, and there is an urgent need for breakthroughs in the treatment of esophageal cancer. This article is aimed at studying the effects of medical treatment and chemotherapy for patients with malignant esophageal cancer. To this end, this article proposes a treatment method based on endoscopy and improves the image imaging of the endoscopy and the image quality of the image and the edge processing of the image. At the same time, this article designs an experiment to conduct statistical analysis of the situation during the treatment process. The experimental results in this article show that the improved treatment method has a 21% increase in success rate compared with the existing treatment method. And the optimized image quality has increased by 27%. It can very well help the attending doctor to improve the efficiency of treatment in the actual treatment process. Its most important contribution is that through the edge optimization and image enhancement processing technology, the success rate of endoscopic treatment has been better improved, and the treatment efficiency has also been improved.

Esophageal squamous cell carcinoma: pathology and prognosis

Between 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in 299 cases (74%), blood vessel invasion in 200 cases (49%), intramural metastasis in 45 (11%), and lymph node metastasis in 232 (58%). In pT1 carcinoma cases, 4% of mucosal carcinomas and 30% of submucosal carcinomas had lymph node metastasis. Tumors with deeper invasion had a higher incidence of lymph node metastasis: 74% of pT3 carcinomas and 83% of pT4 carcinomas. The sites of lymph node metastasis were divided into mediastinal, cervical, and abdominal fields; and rates of lymph node metastasis were 49%, 14%, and 41%, respectively. In all resected cases, the operative mortality rate was 3.2%, and the overall 5-year survival rate was 44.8%. The 5-year survival rate of patients with curative resection (R0 and R1) was 49.5%, whereas patients with palliative resection (R2) did not survive more than 3 years. There was no significant difference in survival relative to tumor location. In curatively resected cases, the significant prognostic factors by multivariate analysis were pT category, vascular invasion, lymph node metastasis, and intramural metastasis. Prognosis of lymph node-positive cases did not depend on the positive node site. Patients with only one positive node had a better prognosis, and those with six or more positive nodes had a poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

High-dose-rate intraluminal brachytherapy for esophageal cancer: 10 years experience in Hyogo College of Medicine

From May 1980 through December 1989, 148 patients with thoracic esophageal cancer were treated with high-dose-rate intraluminal brachytherapy (HDRIBT) following external radiotherapy (ERT). The standard treatment protocol was 60 Gy/6 weeks of ERT and 12 Gy/1 week of HDRIBT. The patients were divided into two groups according to disease stage. Sixty-six patients had limited disease (LD), and 82 patients had extensive disease (ED). The 2-year survival rate was 37% in LD group, and 7% in ED group. The 5-year survival rate of LD group was 18%. The 1- and 2-year actuarial local control rate was 66% and 64% in LD group, and 49% and 45% in ED group, respectively. In the total patients, ulceration, stricture, and fistula were found in 42 (28%), 15 (10%) and 6 (4%) patients, respectively; however, major complication defined as one resulting in a second hospitalization or requiring surgical intervention was 3 of the 42 patients with ulceration, 1 of the 15 patients with stricture, and all of the six patients with fistula. As to cause of death, local failure, local failure with distant metastasis, distant metastasis, intercurrent disease, and unknown reason was 14, 6, 15, 16 and 0 in LD group, and 13, 24, 30, 9 and 1 in ED group, respectively. The technique and method of combined treatment are described in detail.

Surgical therapy of oesophageal carcinoma

During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.