Surgery pp 827-839 | Cite as

Malignant Tumors of the Esophagus

  • Gail Darling


Carcinoma of the esophagus is the 10th leading cause of cancer deaths in North America. The incidence varies considerably from 5 per 100,000 in most Western countries to as high as 100 per 100,000 in some countries such as Iran, Japan, China, and other countries in the “esophageal cancer belt.” The estimated 5-year survival for cancer of the esophagus is 10%. Adenocarcinoma, previously rare, is increasing in incidence in Western countries by approximately 5%–10% per year1,2 and is now the dominant cell type in patients in North America and Europe, although squamous cell carcinoma still dominates globally. In a recent series of patients with esophageal cancer from the Mayo Clinic,3 adenocarcinoma was present in 85.5%. Adenocarcinoma and squamous cell cancer account for almost all cases. Leiomyosarcoma, lymphoma, small-cell carcinoma, and melanoma occur rarely.


Esophageal Cancer Esophageal Carcinoma Preoperative Chemotherapy Radiation Therapy Oncology Group Thoracic Esophagus 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991;265:1287–1289.PubMedCrossRefGoogle Scholar
  2. 2.
    Blot WJ, Devesa SS, Fraumenii JF. Continued climbs in rates of esophageal adenocarcinoma: an update. JAMA 1993;270:1320.PubMedCrossRefGoogle Scholar
  3. 3.
    Visbal AL, Allen MS, Miller DL, Trastek VF, Pairolero PC. Ivor Lewis esophagogastrectomy for esophageal cancer. Ann Thorac Surg 2001;71:1803–1808.PubMedCrossRefGoogle Scholar
  4. 4.
    Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825–831.PubMedCrossRefGoogle Scholar
  5. 5.
    Yang PC, Davis S. Incidence of cancer of the esophagus in the United States by histologic type. Cancer 1988;61:612.PubMedCrossRefGoogle Scholar
  6. 6.
    Rice TW, Blackstone EH, Adelstein DJ, et al. Role of clinically determined depth of tumor invasion in the treatment of esophageal carcinoma. J Thorac Cardiovasc Surg 2003;125:1091–1102.PubMedCrossRefGoogle Scholar
  7. 7.
    Meining A, Dittler HJ, Wolf A, et al. You get what you expect? A critical appraisal of imaging methodology in endosonographic cancer staging. Gut 2002;50:599–603.PubMedCrossRefGoogle Scholar
  8. 8.
    Kelly S, Harris KM, Berry E, et al. A systematic review of the staging performance of endoscopic ultrasound in gastroesophageal carcinoma. Gut 2001;49:534–539.PubMedCrossRefGoogle Scholar
  9. 9.
    Catalano MF, Sivak MV Jr, Rice T, et al. Endosonographic features predictive of lymph node metastases. Gastrointest Endosc 1994;40:442.PubMedGoogle Scholar
  10. 10.
    Vasquez-Sequeiros E, Norton ID, Clain JE, et al. Impact of EUS guided fine needle aspiration in lymph node staging inpatients with esophageal carcinoma. Gastrointest Endosc 2001;53:751–757.CrossRefGoogle Scholar
  11. 11.
    Downey RJ, Akhurst T, Ilson D, et al. Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: the results of a prospective trial. J Clin Oncol 2003;21:428–432.PubMedCrossRefGoogle Scholar
  12. 12.
    Lowe VJ, Booya F, Fletcher JG, et al. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol 2005;7:422–430.PubMedCrossRefGoogle Scholar
  13. 13.
    Yuan S, Yu Y, Chao KS, et al. Additional value of PET/CT over PET in assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer. J Nucl Med 2006;47:1255–1259.PubMedGoogle Scholar
  14. 14.
    Stahl A, Stollfuss J, Ott K, et al. FDG PET and CT in locally advanced adenocarcinomas of the distal oesophagus. Clinical relevance of a discordant PET finding. Nucl Med 2005;44:249–255.Google Scholar
  15. 15.
    Rasanen JV, Sihvo EI, Knuuti MJ, et al. Prospective analysis of accuracy of positron emission tomography, computed tomography and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and esophagogastric junction. Ann Surgical Oncol 2003;10:954–960.CrossRefGoogle Scholar
  16. 16.
    Krasna MJ, Reed CE, Jaklitsch MT, et al. Thoracoscopic staging of esophageal cancer: a prospective, multiinstitutional trial. Cancer and Leukemia Group B Thoracic Surgeons. Ann Thorac Surg 1995;60:1337–1340.PubMedCrossRefGoogle Scholar
  17. 17.
    Krasna MJ, et al. The role of thoracoscopic staging of esophageal cancer patients. Eur J Cardiovasc Surg 1999;16(suppl 1):S31.CrossRefGoogle Scholar
  18. 18.
    Wallace MB, Nietert PJ, Earle C, et al. An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg 2002;74:1026–1032.PubMedCrossRefGoogle Scholar
  19. 19.
    Dimick JB, Wainess RM, Upchurch GR Jr, Iannettoni MD, Orringer MB. National trends in outcomes for esophageal resection. Ann Thorac Surg 2005;79:212–218.PubMedCrossRefGoogle Scholar
  20. 20.
    Orringer MB. Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus. Ann Surg 1984;200:282–288.PubMedCrossRefGoogle Scholar
  21. 21.
    Skinner DB. En bloc resection for neoplasms of the esophagus and cardia. J Thorac Cardiovasc Surg 1983;85:59–71.PubMedGoogle Scholar
  22. 22.
    Luketich JD, et al. Minimally invasive esophagectomy: outcomes in 2222 patients. Ann Surg 2003;238:486.PubMedGoogle Scholar
  23. 23.
    Hulscher JB, Tijssen JG, Obertop H, et al. Transthoracic versus transhiatal resection for carcinoma of the esophagus: a metaanalysis. Ann Thorac Surg 2001;72:306–313.PubMedCrossRefGoogle Scholar
  24. 24.
    Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared to limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662–1669.PubMedCrossRefGoogle Scholar
  25. 25.
    Altorki N, Girardi L, Skinner DB. En bloc esophagectomy improves survival for stage III esophageal cancer. J Thorac Cardiovasc Surg 1997;114:948–956.PubMedCrossRefGoogle Scholar
  26. 26.
    Hagan JA, DeMeester SR, Peters JH, et al. Curative resection for esophageal adenocarcinoma: analysis of 100 enbloc esophagectomies. Ann Surg 2001;234:520–531.CrossRefGoogle Scholar
  27. 27.
    Siewert JR, Stein HJ, Feith M, et al. Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1000 consecutive resection at a single center in the Western world. Ann Surg 2001;234:360–369.PubMedCrossRefGoogle Scholar
  28. 28.
    Urschel JD, Urschel DM, Miller JD, et al. A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg 2002;182:470–475.CrossRefGoogle Scholar
  29. 29.
    Collard J-M, Tinton N, Malaise J, Romagnoli R, Otter J-B, Kestens PJ. Esophageal replacement: gastric tube or whole stomach? Ann Thorac Surg 1995;60:261–267.PubMedCrossRefGoogle Scholar
  30. 30.
    Posthlethwaite RW. Colonic interposition for esophageal substitution: collective review. Surg Gynecol Obstet 1983;156:377.Google Scholar
  31. 31.
    Gaissert HA, et al. Short-segment intestinal interposition of the distal esophagus. J Thorac Cardiovasc Surg 1993;106:860.PubMedGoogle Scholar
  32. 32.
    Heitmiller RF, et al. Long segment substernal jejunal esophageal replacement with internal mammary vascular augmentation. Dis Esophagus 2000;13:240.PubMedCrossRefGoogle Scholar
  33. 33.
    Chen HC, Tang YB. Microsurgical reconstruction of the esophagus. Semin Surg Oncol 2000;19:235.PubMedCrossRefGoogle Scholar
  34. 34.
    Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg 2000;119:277–288.PubMedCrossRefGoogle Scholar
  35. 35.
    Casson AG, Porter GA, Veugelers PJ. Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. Dis Esophagus 2002;15:296–302.PubMedCrossRefGoogle Scholar
  36. 36.
    Ercan S, Rice TW, Murthy SC, Rybicki LA, Blackstone EH. Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer? J Thorac Cardiovasc Surg 2005;129:623–631.PubMedCrossRefGoogle Scholar
  37. 37.
    Urschel JD, Blewett CJ, Bennett WF, et al. Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Dis Esophagus 2001;14:212–217.PubMedCrossRefGoogle Scholar
  38. 38.
    Beitler AL, Urschel JD. Comparison of stapled and hand-sewn esophagogastric anastomoses. Am J Surg 1998;175:337–340.PubMedCrossRefGoogle Scholar
  39. 39.
    Chasseray VM, Kiroff GK, Buard JL, Launois B. Cervical or thoracic anastomosis for esophagectomy for carcinoma. Surg Gyn Obstet 1989;169:55–62.Google Scholar
  40. 40.
    Honkoop P, Siersema PD, Tilanus HW, Stassen LPS, Hop WCJ, van Blankenstein M. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg 1996;111:1141–1148.PubMedCrossRefGoogle Scholar
  41. 41.
    Iannettoni MD, Whyte RI, Orringer MB. Catastrophic complications of the cervical esophagogastric anastomosis. J Thorac Cardiovasc Surg 1995;110:1493–1501.PubMedCrossRefGoogle Scholar
  42. 42.
    Wong J. Esophageal resection for cancer: the rationale of current practice. Am J Surg 1997;153:18.CrossRefGoogle Scholar
  43. 43.
    Burgess HM, et al. Carcinoma of the esophagus: clinicopathologic study. Surg Clin North Am 1991;31:965.Google Scholar
  44. 44.
    Urschel JD, Blewett CJ, Young JE, et al. Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials. Dig Surg 2002;19:160–164.PubMedCrossRefGoogle Scholar
  45. 45.
    Fok M, Cheng SW, Wong J. Pylorplasty versus no drainage in gastric replacement of the esophagus. Am J Surg 1991;162:447–452.PubMedCrossRefGoogle Scholar
  46. 46.
    Law S, Cheung MC, Fok M, Chu KM, Wong J. Pyloroplasty and pylormyotomy in gastric replacement of the esophagus after esophagectomy: a randomized trial. J Am Coll Surg 1997;184:630–636.PubMedGoogle Scholar
  47. 47.
    Medical Research Council Oesophageal Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized trial. Lancet 2002;359:1727–1733.CrossRefGoogle Scholar
  48. 48.
    Kelsen DP, Ginsberg RJ, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 1998;339:1979–1984.PubMedCrossRefGoogle Scholar
  49. 49.
    Malthaner R, Fenlon D. Preoperative chemotherapy for resectable thoracic esophageal cancer. (Cochrane Review) In: The Cochrane Library Issue 1. Chichester, UK: John Wiley and Sons Ltd., 2004.Google Scholar
  50. 50.
    Malthaner R, Fenlon D. Preoperative chemotherapy for resectable thoracic esophageal cancer. Cochrane Database Syst Rev 2001;1(1):1699.Google Scholar
  51. 51.
    Urschel JD, Vasan H, Blewett CJ. A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2002;183:274–279.PubMedCrossRefGoogle Scholar
  52. 52.
    Bhansali MS, Vaidya JS, Bhatt RG, Patil PK, Badwe RA, Desai PB. Chemotherapy for carcinoma of the esophagus: a comparison of evidence from meta-analyses of randomized trials and of historical control studies. Ann Oncol 1996;7:355–359.PubMedGoogle Scholar
  53. 53.
    Cunningham D, Allum WH, Stenning SP, et al. and the MAGIC trial participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11–20.PubMedCrossRefGoogle Scholar
  54. 54.
    Pouliquen X, Levard H, Hay JM, et al. 5-Fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Association for Surgical Research. Ann Surg 1996;223:127–133.PubMedCrossRefGoogle Scholar
  55. 55.
    Ando N, Iizuka T, Kakegawa T, et al. A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study. J Thorac Cardiovasc Surg 1997;114:205–209.PubMedCrossRefGoogle Scholar
  56. 56.
    Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared to surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study JCOG 9204. J Clin Oncol 2003;21:4592–4596.PubMedCrossRefGoogle Scholar
  57. 57.
    Malthaner R, Wong RKS, Rumble RB, Zuraw L. Neoadjuvant or adjuvant therapy for resectable esophageal cancer. Practice Guideline Report 2-11. Program in Evidence Based Care, Cancer Care Ontario, 2002. Available at: PEBC.htm.Google Scholar
  58. 58.
    Rice TW, Adelstein DJ, Chidel MA, et al. Benefit of postoperative adjuvant chemoradiotherapy in locoregionally advanced esophageal carcinoma. J Thorac Cardiovasc Surg 2003;126:1590–1596.PubMedCrossRefGoogle Scholar
  59. 59.
    MacDonald J, Smalley S, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725.PubMedCrossRefGoogle Scholar
  60. 60.
    Arnott SJ, Duncan W, Gignoux M, et al. Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev 2000;4:CD001799.Google Scholar
  61. 61.
    Xiao ZF, Yang ZY, Liang J, et al. Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients. Ann Thorac Surg 2003;75:331–336.PubMedCrossRefGoogle Scholar
  62. 62.
    Fok M, McShane J, Law SYK, Wong J. Prospective randomized study in the treatment of oesophageal carcinoma. Asian J Surg 1994;17:223–229.Google Scholar
  63. 63.
    Badwe RA, Sharma V, Bhansali MS, et al. The quality of swallowing for patients with operable esophageal carcinoma. Cancer 1999;85:763–768.PubMedCrossRefGoogle Scholar
  64. 64.
    Cooper JS, Guo MD, Herskoviv A, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999;281:1623–1627.PubMedCrossRefGoogle Scholar
  65. 65.
    Denham JW, Steigler A, Kilmurray J, et al. Relapse patterns after chemo-radiation for carcinoma of the oesophagus. Clin Oncol (R Coll Radiol) 2003;15:98–108.Google Scholar
  66. 66.
    Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase HI trial of combined modality therapy for esophageal cancer: high dose versus standard-dose radiation therapy. JCO 2002;20:1167–1174.CrossRefGoogle Scholar
  67. 67.
    Wong RKS, Malthaner RA, Zuraw L, et al. Cancer Care Ontario Practice Guidelines Initiative Gastrointestinal Cancer Disease Site Group. Combined modality radiotherapy and chemotherapy in the non-surgical management of localized carcinoma of the esophagus. Int J Radiat Oncol Biol Phys 2003;55(4):930–942.PubMedGoogle Scholar
  68. 68.
    Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2003;185:538–543.PubMedCrossRefGoogle Scholar
  69. 69.
    Guili R, Gignoux M. Treatment of carcinoma of the esophagus. Ann Surg 1980;192,44-52.Google Scholar
  70. 70.
    Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma. A critical review of surgery. Br J Surg 1980;67:381–390.PubMedCrossRefGoogle Scholar
  71. 71.
    Posthlethwait RW. Complications and deaths after operations for esophageal carcinoma. J Thorac Cardiovasc Surg 1983;85:827–831.Google Scholar
  72. 72.
    Ellis FH Jr. Carcinoma of the Esophagus. CA Cancer J Clin 1983;33:264.PubMedCrossRefGoogle Scholar
  73. 73.
    Katariya K, et al. Complications of transhiatal esophagectomy. J Surg Oncol 1994;57:157.PubMedCrossRefGoogle Scholar
  74. 74.
    Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 1999;230:392.PubMedCrossRefGoogle Scholar
  75. 75.
    Ellis FH Jr. Standard resection for cancer of the esophagus and cardia. Surg Oncol Clin Am 1999;8:279–294.Google Scholar
  76. 76.
    Altorki NK. The rationale for radical resection. Surg Oncol Clin N Am 1999;8:295–305.PubMedGoogle Scholar
  77. 77.
    Altorki NK, Kent M, Ferrara C, Port J. Three field lymph node dissection for squamous and adenocarcinoma of the esophagus. Ann Surg 2002;236:177–183.PubMedCrossRefGoogle Scholar
  78. 78.
    Bailey SH, Bull DA, Harpole DH, et al. Outcomes after esophagectomy: a ten year prospective cohort. Ann Thorac Surg 2003;75:217–222.PubMedCrossRefGoogle Scholar
  79. 79.
    Orringer MB. In Glenn’s Thoracic and Cardiovascular Surgery (5th ed.) Norwalk, Connecticut: Appletion & Lange, 1991;53:801.Google Scholar
  80. 80.
    Law S, Fok M, Chow S, Chu KM, Wong J. Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 1997;114:210–217.PubMedCrossRefGoogle Scholar
  81. 81.
    Ancona E, Ruol A, Santi S, et al. Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone. Cancer 2001;91:2165–2174.PubMedCrossRefGoogle Scholar
  82. 82.
    Schlag PM. Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus. The Chirurgische Arbeitsgemeinschaft Fuer Onkologie der Deutschen Gesellschaft Fuer Chirurgie Study Group. Arch Surg 1992;127:1446–1450.PubMedGoogle Scholar
  83. 83.
    Maipang T, Vasinanukorn P, Petpichetchian C, et al. Induction chemotherapy in the treatment of patients with carcinoma of the esophagus. J Surg Oncol 1994;56:191–197.PubMedCrossRefGoogle Scholar
  84. 84.
    Nygaard K, Hagen S, Hansen HS, et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 1992;16:1104–1110.PubMedCrossRefGoogle Scholar
  85. 85.
    Apinop C, Puttisak P, Preecha N. A prospective study of combined therapy in esophageal cancer. Hepatogastroenterology 1994;41:391–393.PubMedGoogle Scholar
  86. 86.
    Le Prise E, Etienne PL, Meunier B, et al. A randomized study of chemotherapy, radiation therapy and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994;73:1779–1784.PubMedCrossRefGoogle Scholar
  87. 87.
    Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996;335:462–467.PubMedCrossRefGoogle Scholar
  88. 88.
    Bosset JF, Gignoux M, Triboulet JP, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of the esophagus. N Engl J Med 1997;337:161–167.PubMedCrossRefGoogle Scholar
  89. 89.
    Urba SG, Orringer MB, Turrissi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradia-tion versus surgery alone in patients with locoregional esophageal carcinoma, J Clin Oncol 2001;9:305–313.Google Scholar
  90. 90.
    Burmeister BH, Smithers BM, Gebski V, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomized controlled phase III trial. Lancet Oncol 2005;6:659–668.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Gail Darling
    • 1
  1. 1.Department of Thoracic SurgeryUniversity Health NetworkTorontoCanada

Personalised recommendations