- T. Benhidjeb
- P.M. Schlag
- Acta Chirurgica Austriaca
- Acta Chir Austriaca 31 (1): 5-8
Background: The dismal prognosis of patients with an esophageal carcinoma can only be improved by R0 resection. However, this condition is very difficult to be achieved in cases with locally advanced (pT4)-tumors. Methods: This paper reviews the result of diagnostics and neoadjuvant therapeutic modalities in patients with esophageal carcnioma that invades adjacent organs. Results: Endosonography (7,5 and 12 MHz frequencies) is with an accuracy rate of approximately 86% actually the most accurate method for staging esophageal carcinoma. Randomized clinical trials indicate that neoadjuvant radiotherapy does not increase the resection rate or prolong survival (5-year survival rate 9,5 to 16%) compared to surgical resection alone. Data from several series suggest that preoperative cisplatin-based chemotherapy is effective, but it is associated with a high perioperative morbidity (>45%) and mortality(>15%) rate. Neoadjuvant radio-chemotherapy appears to improve the prognosis only in those patients with objective clinical or histopathologic response. Due to a high postoperative mortality, combined resection of the tracheobronchial tree and aorta is considered too invasive and therapeutically not worthwhile. When patients are appropriately selected, a combined pulmonary (including lobectomy), pericard and esophageal resection is a relatively safe procedure. The survival curve seems to be better in there patients groups. Conclusion: Paritens with locally advanced esophageal carcinoma should undergo neoadjuvant treatment. This should be performed on appropriately selected cases and in experienced center within the context of clinical trials. The available data on the role of neoadjuvant radio-chemotherapy are not conclusive and recommendation can not yet be given. Multivisceral resection should be performed only if complete tumor resection can be anticipated and only in those patients who respond to neoadjuvant treatment modalities.