The patient data on esophageal cancer are presented at our bi-weekly conferences, attended by medical oncologists, endoscopists, radiologists and thoracic surgeons. In this conference, new cases are clinically staged in detail by image diagnosis. When the lesion is assessed as surgically resectable (stage I to III), staff thoracic surgeons operate on the patient with 1 to 3 residents, in accordance with standard procedures, after obtaining informed consent from the patient. Approximately 20 patients are surgically managed every year. For those with early cancer, who are not assessed as suitable candidates for endoscopic mucosal resection, or who have high-risk conditions, we advocate a transhiatal pull-through esophagectomy or mini-thoracotomy approach assisted with videothoracoscopy.
Since patients in the far advanced stage (T4, or M1 LYM in clinical staging) are treated with chemoradiotherapy as a first choice in our hospital, most T4 cases in stage III of the TNM classification are not indicated for surgery. As a result, survival rates in surgical cases are much better than those reported in the literature, as shown in table 2. However, the surgical outcome has been very poor in patients with swelling mediastinal lymph nodes preoperatively detected by CT scan. Therefore, we are attempting neoadjuvant chemoradiotherapy as a pilot study, and there have been 9 patients enrolled into this trial since 1993. Although postoperative morbidity was high in this population, four patients showed pathological CR (complete response), and are expected to be cured and enjoy better survival.
The treatment results of chemoradiotherapy for far advanced cases are generally fair to date, as shown in the report of gastrointestinal oncology, but the prognosis of the T4 cases is particularly poor. As a result, we have started to plan a new protocol for salvage operation of these cases.
|Year||No. of cases|
|TNM stage||No. of|
|Survival rate (%)|
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