Controversies in esophageal cancer surgery

The current management of esophageal cancer is controversial. Parenteral nutrition in selected patients resulted in lower complication and death rates than in untreated patients. With respect to surgical management, esophagectomy without thoracotomy has given survival rates similar to more radical operations. The pattern of recurrence as well as morbidity and mortality necessitate a well-planned assessment in order to compare it with esophagectomy using a standard approach. An esophageal anastomosis in the neck seems to be at a higher risk for fistula formation than reconstruction in the chest. An instrument-made anastomosis results in fewer fistulas but a higher stricture rate than hand-made anastomosis. A large proportion of patients with esophageal cancer will receive only palliative benefit because of nonresectability; esophageal bypass offers a good quality of survival but is associated with high morbidity and mortality. Palliative intubation seems to offer the quickest and simplest method of restoring reasonable swallowing.