Clinical study of penile carcinoma in 38 cases

We retrospectively reviewed 38 patients with primary penile squamous cell carcinoma (stage 1 in 22, stage 2 in 7 and stage 3 in 9) who were treated in our institution from 1963 through 1987. The incidence of regional nodal metastasis was correlated with tumor category, local infiltration and tumor grade. The incidence rate of nodal metastasis of G2 and G3 tumors was statistically higher than that of G1 tumors. Of 27 patients initially treated by radiotherapy and/or chemotherapy, 11 patients achieved complete response. G1 tumors and T1 to 2 tumors had such high response rates as 58 and 50 per cent, respectively, but 5 patients (45 per cent) had local recurrence at an average of 74 months after initial treatment. The 5-year survival rates of over-all, stage 1, 2 and 3 were 73, 90, 75 and 25 per cent, respectively. Patients with stage 3 disease had a statistical lower survival rate than those with stage 1 or 2 disease. Among 13 patients with regional nodal metastasis, none with G2 tumor survived three years, although 3 patients (60 per cent) of those with G1 tumor survived five years. These results suggest that tumor grade is the most prognostic factor for the regional nodal metastasis, the response of conservative treatment and the survival of metastasized patients.     

Primary Malignant Mediastinal Tumors

Thirty-eight patients with primary malignant mediastinal tumors of all cell types are the basis for this review. Eleven of these patients had germ cell tumors. Five germ cell tumors were seminomas, two were malignant teratomas, and two were endodermal sinus tumors. Mean survival for all patients with germ cell tumors was 3.3 years. Eight children had surgical excision of mediastinal neuroblastomas, and all but 1 are alive for a mean survival of 6.7 years. Seven patients had lymphoproliferative disorders; 6 of these patients had nodular sclerosing Hodgkin's disease, and 1 had lymphoblastic (thymic) lymphoma. Mean survival was 5.1 years. There were five carcinomas of various cell types and one angiopericytoma. None of the patients with these lesions survived more than 2 years. Four patients had thymoma with an average survival of 3.7 years. Two patients had carcinoid tumors of thymic origin; neither survived more than 1 year.In 1972, we reported 5-year disease-free survival of 26% in a series of patients with primary mediastinal tumors. Our experience since 1970 shows current survival of 47.3% and 5-year disease-free survival of 34.2%. We use combined methods of therapy, including aggressive surgical resection, combination chemotherapy, and often mediastinal irradiation for most types of mediastinal tumors. Primary mediastinal malignancies should be treated aggressively using a multidisciplinary approach, since many of these tumors are curable.     

Cisplatin, cyclophosphamide and doxorubicin chemotherapy for unresectable urothelial tumors: the M.D. Anderson experience

We reviewed retrospectively 97 patients treated with cisplatin, cyclophosphamide and doxorubicin chemotherapy at our hospital to evaluate predictive variables for response to chemotherapy and long-term survival free of disease. Histological subtype influenced response: 70 per cent of the patients with pure transitional cell carcinoma achieved an objective response (partial remission 31 per cent and complete remission 39 per cent), whereas 45 per cent of those with mixed tumors achieved response (partial remission 20 per cent and complete remission 25 per cent). Patients with nodal metastases only had an equal over-all response rate to those with visceral metastasis (64 versus 62 per cent) but patients with nodal metastases had a higher complete remission rate (45 versus 20 per cent). A total of 35 patients (36 per cent) achieved a complete response. In 17 of the 35 patients the duration of response was less than 100 weeks and 18 (51 per cent) have survived longer than 100 weeks. Of the 17 patients with a survival free of disease of less than 100 weeks 16 died of recurrent urothelial tumors and 1 died of a second primary tumor. Among the patients with a survival free of disease of longer than 100 weeks only 2 have had recurrent urothelial tumors; 72 per cent of the patients in this category remain free of disease. Patients with pure transitional cell carcinoma were represented in equal frequency among patients achieving a durable complete remission and those with a complete remission of less than 100 weeks. These data demonstrate the ability of cisplatin, cyclophosphamide and doxorubicin combination chemotherapy to achieve a complete remission and long-term survival free of disease among select patients with unresectable urothelial tumors.     

Bypass operation for advanced esophageal cancer--an analysis of 93 cases

From 1973 to 1987, 235 patients with esophageal squamous cell carcinoma were treated at Hiroshima University. Of these patients, 121 (51.5 per cent) were submitted to esophagectomy, 93 (39.6 per cent) to bypass surgery and 21 (8.9 per cent) to either exploratory or no surgery. In this report, the 93 cases who underwent bypass surgery were analysed. Ten patients died within thirty days after their operation (10.8 per cent) and there were 33 cases of hospital death (35.5 per cent). Following the bypass surgery, 49 (59.0 per cent) cases were able to tolerate over 50 per cent of their normal oral intake and 22 cases (26.5 per cent) were able to tolerate between 25 per cent and 50 per cent. For twelve cases (14.6 per cent), however, oral ingestion proved impossible up until the time of death due to such complications as leakage. The overall survival rates were 44.3 per cent at 6 months, 12.7 per cent at 1 year and 2.8 per cent at 5 years, respectively. Two cases survived for over 5 years. Hyperthermia was applied in combination with chemotherapy from 1981, however, no case survived for over one year without radiation therapy. Recently, radiation plus hyperthermia is being performed in combination with immunochemotherapy.     

Bypass operation for advanced esophageal cancer —An analysis of 93 cases—

From 1973 to 1987, 235 patients with esophageal squamous cell carcinoma were treated at Hiroshima University. Of these patients, 121 (51.5 per cent) were submitted to esophagectomy, 93 (39.6 per cent) to bypass surgery and 21 (8.9 per cent) to either exploratory or no surgery. In this report, the 93 cases who underwent bypass surgery were analysed. Ten patients died within thirty days after their operation (10.8 per cent) and there were 33 cases of hospital death (35.5 per cent). Following the bypass surgery, 49 (59.0 per cent) cases were able to tolerate over 50 per cent of their normal oral intake and 22 cases (26.5 per cent) were able to tolerate between 25 per cent and 50 per cent. For twelve cases (14.6 per cent), however, oral ingestion proved impossible up until the time of death due to such complications as leakage. The overall survival rates were 44.3 per cent at 6 months, 12.7 per cent at 1 year and 2.8 per cent at 5 years, respectively. Two cases survived for over 5 years. Hyperthermia was applied in combination with chemotherapy from 1981, however, no case survived for over one year without radiation therapy. Recently, radiation plus hyperthermia is being performed in combination with immunochemotherapy.     

Testicular tumors in infants and children

Forty three children with testicular tumors have been presented. Eighty per cent of these tumors were malignant, and 60 per cent occurred in children less than two and one half years of age. Twenty of the 24 malignant germinal tumors were embryonal cell carcinomas. The mean age of the patients at presentation of these tumors was 18 months. Nine patients underwent orchiectomy alone, and five of these have died. Eleven received combined therapy, and all have survived. We currently recommend radical orchiectomy and extended unilateral retroperitoneal lymphadenectomy. If examination of the nodes reveals evidence of metastases, a bilateral dissection is done. Radiotherapy is given only in the presence of nodal metastases. Adjuvant chemotherapy with vincristine, actinomycin D, and Cytoxan is given for two years to all patients with malginant nonseminomatous germ cell tumors or sarcomas.     

Experience with resection of primary hepatic malignancy

Our experience with hepatic resection for 106 primary hepatic malignancies has been summarized as a part of a total experience with 411 hepatic resections for various indications. The operative mortality rate (death within a month) was 8.5 per cent in treating primary hepatic malignancy, which is significantly higher than that of treating hepatic metastases (0 of 123 resections). Overall operative mortality of 411 hepatic resection was 3.2 per cent. A high operative risk was noted in patients with gross cirrhosis, trauma, abscess, and large malignant tumors. The 1-, 3-, and 5-year survival rates of patients with primary hepatic malignancy were 68.5 per cent, 45.1 per cent, and 31.9 per cent, respectively. Survival rates of patients with fibrolamellar hepatocellular carcinoma were significantly higher than those of patients with nonfibrolamellar hepatocellular carcinoma. Eighteen patients survived more than 5 years after hepatic resection, 14 of whom had been treated by trisegmentectomy. The most extensive partial hepatectomy, such as right and left trisegmentectomy rather than extended lobectomies, should be used to remove massive tumors with adequate tumor-free margins.     

Indolent nonseminomatous germ cell tumor of testis. Prolonged survival of patient with persistent metastatic disease

The complete response rate of disseminated nonseminomatous germ cell tumors (NSGCT) of the testes with current aggressive chemotherapy and surgical resection of residual disease is between 70 and 80 per cent. Those patients who do not attain complete response tend to have short survivals. A case is presented of a forty-one-year-old white man who has had nearly continuous evidence of metastatic embryonal carcinoma for more than eleven years. Although NSGCTs are characterized by rapid proliferation, early metastasis, high response rate to chemotherapy, and rapid death if uncontrolled, this case demonstrates an indolent form of disease with poor response to chemotherapy and yet prolonged survival in spite of uncontrolled disease. This is the first reported case of indolent metastatic germ cell neoplasm with survival of more than ten years.     

Nonfunctioning islet cell carcinoma of the pancreas: case report

Islet cell carcinomas have an incidence of 5 per million per year; 50 per cent of these are nonfunctioning islet cell tumors. The presenting symptoms mimic pancreatic ductal adenocarcinoma. The CT finding of a pancreatic head mass that spares the main duct may distinguish between the two. The treatment of choice is resection. Most nonfunctioning islet cell tumors are not discovered until metastases are present. However, favorable survival rates have been reported in locally advanced tumors that have undergone resection. Liver metastases carry an unfavorable prognosis. Five-year survival over 60 per cent has been reported. Node-negative patients have a median survival of more than 10 years, and node-positive patients who have undergone resection have a median survival of 75 months. Streptozotocin and 5-fluorouracil are used postoperatively in patients with advanced disease. Considering the favorable survival with resection aggressive surgical treatment is mandated in cases of nonfunctioning islet cell tumors.     

Multimodality treatment for esophageal cancer: the role of surgery and neoadjuvant therapy

Treatment of esophageal cancer has traditionally included surgery as the initial modality. Neoadjuvant chemoradiation therapy has been introduced with the goal of downstaging tumors before surgical resection; however, its role in esophageal cancer remains controversial. We report 116 patients who underwent esophagogastrectomy with reconstruction for carcinoma of the esophagus or esophagogastric junction over a 10-year period (January 1, 1990 to June 1, 2001). Forty patients underwent neoadjuvant radiation and chemotherapy followed by surgery. Hospital mortality in this group was 7.5 per cent, complete pathologic response (CPR) was 37.5 per cent, and overall 3- and 5-year survival rates were 47 and 38 per cent. Five-year survival in the 15 patients with CPR was 85 per cent. Five patients underwent neoadjuvant single-agent therapy (four chemotherapy and one radiation) followed by surgery, and none survived to 3 years. Seventy-one patients underwent surgery without neoadjuvant therapy. Hospital mortality in this group was 1.4 per cent, with 3- and 5-year survival of 21 and 17 per cent--a decreased long-term survival compared with the neoadjuvant therapy group despite the observation that patients who underwent neoadjuvant therapy had a larger tumor size on presentation (5.5 +/- 0.4 cm vs 3.8 +/- 0.2 cm; P = 0.002). Squamous cell carcinomas seemed to be more responsive to neoadjuvant radiation and chemotherapy followed by surgery than were adenocarcinomas, with a CPR of 44.4 versus 35.5 per cent; however, 5-year survival rates in these complete responders were not significantly different (100% and 78%, respectively; P = 0.97). We report that esophagogastrectomy in conjunction with neoadjuvant therapy results in increased survival compared with surgery without neoadjuvant therapy (P < 0.01), although there may be an increased perioperative mortality associated with neoadjuvant therapy. Further studies are needed to evaluate the role of preoperative chemoradiation and to better identify the pretreatment characteristics of patients with a complete pathological response.     

Late relapse of testicular germ cell tumors

The successful multidisciplinary approach for the management of germ cell tumors of the testis has resulted in survival rates of greater than 90% overall. While the majority of relapses in patients with germ cell tumors occur within the first 2 years of treatment, the incidence of late relapse beyond 2 years has been increasing over recent years. The pattern of late relapse suggests that an inadequately controlled retroperitoneum is a major predisposing factor, with up to 80% of late relapses occurring in the retroperitoneum. These tumors tend to be chemorefractory and overall prognosis for patients with late relapse of germ cell tumors is relatively poor, with survival rates of approximately 30% to 40%. In this review, we present the recent data regarding the clinical presentation, patterns of relapse, histologic findings, appropriate treatment options, and outcomes for men with late relapse of germ cell tumors.     

Testicular cancer: prognostic implications of vascular invasion

In a retrospective study the primary tumors of 33 patients with seminomas and 53 with nonseminomatous germ cell tumors were re-evaluated for vascular invasion. The significance of vascular invasion was analyzed in respect to the appearance of visceral metastases and the effect of adjuvant chemotherapy. Vascular invasion was demonstrated in 27 per cent of the patients with seminomas and 53 per cent with nonseminomatous germ cell testis tumors, while visceral metastases appeared in 9 and 32 per cent, respectively. Without adjuvant chemotherapy all 13 patients with nonseminomatous germ cell testis tumors and vascular invasion had metastases, compared to only 3 of 13 without vascular invasion (p less than 0.0005). Of 9 patients with seminoma and vascular invasion 3 had tumor progression, compared to 1 of 24 without vascular invasion (p greater than 0.05). With adjuvant chemotherapy only 1 of 15 patients (7 per cent) with nonseminomatous germ cell testis tumors and vascular invasion had metastases, compared to 100 per cent of 13 without this treatment. No significant correlation was noted between pT stage versus vascular invasion and pT stage versus tumor progression. The results demonstrate the importance of vascular invasion in the staging of and choice of treatment for early nonseminomatous germ cell testis tumors.     

Combination of hepatic arterial infusion and systemic chemotherapy for gastric cancer with synchronous hepatic metastases

Between 1964 and 1981, seventy-two Japanese patients with gastric cancer associated with hepatic metastases, in whom the primary tumor had been resected, were treated in a nonrandomized manner at the Second Department of Surgery, Kyushu University Hospital. Fourteen received hepatic arterial infusion (HAI) of 5-FU and Mitomycin C (MMC) combined with systemic chemotherapy, 26 combination systemic chemotherapy of MMC, Futraful and PSK, 18 single drug (MMC) therapy, and 14 no chemotherapy. The average survival was 264 days in HAI combined with systemic chemotherapy, 208 in the combination systemic chemotherapy, 156 in the single drug therapy and 135 in those given no chemotherapy. One year survival and nine month survival rates were 21.4 per cent and 42.9 per cent in HAI combined with systemic chemotherapy, 11.5 per cent and 19.2 per cent in the combination systemic chemotherapy, 5.6 per cent and 11.1 per cent in the single drug therapy and 7.1 per cent and 14.3 per cent in the no chemotherapy group, respectively (HAI vs single drug therapy and no chemotherapy, p<0.01). Five of 14 patients treated with HAI combined with systemic chemotherapy showed a partial response (>50 per cent reduction in tumor size), and the average survival time was 335 days, while that of nonresponders was 224 days. Six of 14 patients treated with combination infusion therapy with MMC and 5-FU survived 314 days, as compared to 201 days for patients with infusion of 5-FU alone.     

Combination of hepatic arterial infusion and systemic chemotherapy for gastric cancer with synchronous hepatic metastases

Between 1964 and 1981, seventy-two Japanese patients with gastric cancer associated with hepatic metastases, in whom the primary tumor had been resected, were treated in a nonrandomized manner at the Second Department of Surgery, Kyushu University Hospital. Fourteen received hepatic arterial infusion (HAI) of 5-FU and Mitomycin C (MMC) combined with systemic chemotherapy, 26 combination systemic chemotherapy of MMC, Futraful and PSK, 18 single drug (MMC) therapy, and 14 no chemotherapy. The average survival was 264 days in HAI combined with systemic chemotherapy, 208 in the combination systemic chemotherapy, 156 in the single drug therapy and 135 in those given no chemotherapy. One year survival and nine month survival rates were 21.4 per cent and 42.9 per cent in HAI combined with systemic chemotherapy, 11.5 per cent and 19.2 per cent in the combination systemic chemotherapy, 5.6 per cent and 11.1 per cent in the single drug therapy and 7.1 per cent and 14.3 per cent in the no chemotherapy group, respectively (HAI vs single drug therapy and no chemotherapy, p less than 0.01). Five of 14 patients treated with HAI combined with systemic chemotherapy showed a partial response (greater than 50 per cent reduction in tumor size), and the average survival time was 335 days, while that of nonresponders was 224 days. Six of 14 patients treated with combination infusion therapy with MMC and 5-FU survived 314 days, as compared to 201 days for patients with infusion of 5-FU alone.     

Recurrent gastric carcinoma —Analysis of 100 in-patients—

Between 1964 and 1981, 100 in-patients with recurrent gastric carcinoma following curative resection were investigated in the Second Department of Surgery, Kyushu University Hospital. The diseasefree interval after initial operation and the advancement of the carcinoma correlated. The mean disease free interval of cases with local recurrence was 4 years and 1 month, that is 2 years longer than in cases of peritoneal dissemination or hematogenous metastasis. The disease free interval and the survival time after recurrence also correlated. Patients with a relapse more than 2 years after initial operation survived statistically longer than did those with a relapse in less than 2 years (p<0.01). One and 2 year survival rates after recurrence in the second resection group was 41.4 per cent and 17.2 per cent, respectively. Almost all patients in the other group died within one year after recurrence. The average survival in patients on a combination of chemotherapy and resection of the recurrent tumor was about 2 years and longer than in cases of resection but without chemotherapy.     

Reassessment of the role of adjunctive surgical therapy in the treatment of advanced germ cell tumors

We treated 30 patients for stage B3 or B3C germ cell tumors between December 1978 and December 1983. After initial, high dose, platinum-based combination chemotherapy, all patients underwent adjunctive resection of all clinically evident residual disease. Residual malignant elements were found in the retroperitoneum in 35 per cent of 26 nonseminomatous germ cell tumor patients and in 40 per cent of those with residual lesions beyond the retroperitoneum following chemotherapy. After additional chemotherapy, including platinum plus etoposide for patients with residual malignant elements, 80 and 75 per cent of those with stages B3 and B3C disease, respectively, achieved a complete sustained remission at a mean followup of 30 to 38 months, respectively. The strongest predictors of ultimate treatment failure were the presence of extensive pulmonary disease at presentation and the finding of residual malignant elements in resected lesions. Of 4 patients with seminoma 3 achieved sustained complete remission, while 1 died of recurrent embryonal carcinoma. These data support the role of adjunctive resection of clinically evident residual lesions following initial platinum-based chemotherapy in advanced metastatic germ cell tumors, and demonstrate the efficacy of additional platinum-etoposide-based chemotherapy in the 35 to 40 per cent of patients who harbor residual malignant disease in resected lesions.     

Squamous cell carcinoma of the anus at one hospital from 1948 to 1984

Two hundred and twenty-eight patients with anal carcinoma treated between 1948 and 1984 were reviewed. Of 145 with anal canal carcinoma, 118 were treated by total anorectal excision, nine by local excision and 13 by radiotherapy. Fifteen patients were inoperable. There were five postoperative deaths. Crude and cancer-specific survival rates of 123 patients treated 5 or more years previously were 58 and 64 per cent. These rates for patients undergoing total anorectal excision were 62 and 65 per cent, and local excision 87 and 100 per cent. Eighty-three patients had carcinoma of the anal margin. Of these, 55 were treated by local excision, 18 by total anorectal excision and 20 by radiotherapy. Eight patients were inoperable. Crude and cancer-specific survival rates for 72 patients followed for 5 years were 55 and 57 per cent with respective rates of 65 and 69 per cent after local excision and 36 and 40 per cent after total anorectal excision. The 5-year survival rate of 27 patients with TNM N1 stage was 48 per cent. Histological confirmation was obtained in only nine of these patients, however, but five (55 per cent) survived 5 years after block dissection or radiotherapy. Metachronous lymphadenopathy occurred in 25 patients. The 5-year survival rate in the 23 cases that were histologically confirmed was 35 per cent after block dissection (17 cases) and radiotherapy (four cases). Using a modification of Papillon's T classification for anal canal carcinoma, stage correlated with survival after combining T1 with T2 tumours and T2 with T3 tumours. Five-year survival rates in these groups were 60 and 54 per cent respectively. The TN M-UICC classification for anal margin carcinoma correlated with survival in a similar manner. The 5-year survival rate was 65 per cent for patients with T1 and T2 tumours and 33 per cent for those with T3 and T4 tumours.     

Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum for advanced germ cell testis tumors: Brazilian experience

Disseminated germ cell testicular cancer proved to be highly sensitive to platinum-containing chemotherapy regimens. We present data concerning the treatment of advanced seminoma and nonseminomatous tumors in a developing country. We treated 30 patients with advanced germ cell testis tumors with 3 or 4 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum. Surgical resection of residual masses was done 30 days after completion of chemotherapy in 18 patients. The histology of the primary tumor was seminoma in 13 patients and nonseminomatous tumors in 17. Toxicity was mild and no treatment-related deaths occurred. All 13 patients (100 per cent) with seminoma and 12 of 17 patients (71 per cent) with nonseminomatous tumors had a complete response to chemotherapy, and 1 of 17 patients was free of disease after a debulking operation and additional chemotherapy. A total of 3 patients with seminoma and 2 with nonseminomatous tumors had recurrences 5 to 8 months after an initial complete response and received additional chemotherapy (VP-16 regimen) with or without radiotherapy. Complete clinical response was achieved in 4 of 5 patients. Median followup was 24 months (range 8 to 38 months) in the 13 patients with seminoma and 28 months (range 9 to 58 months) in those with nonseminomatous tumors, and 13 (100 per cent) and 12 (71 per cent), respectively, are alive without evidence of disease. These data suggest that the protocol of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum is highly effective and minimally toxic in the treatment of disseminated germ cell testicular cancer, inducing an 83 per cent long-lasting clinical remission. Seminomas seem to be equally or even more sensitive than nonseminomatous tumors to this platinum-containing chemotherapy regimen. Recurrence after initial complete response can be treated successfully with regimens containing VP-16.     

Sarcomas of the retroperitoneum and genitourinary tract

A total of 62 patients with retroperitoneal or genitourinary sarcoma was treated at our institutions during the last 46 years. Of the patients 51 were followed for at least 5 years or until they died (median followup 11 years); 5 patients were lost to followup. The most common site was the retroperitoneum. Liposarcoma, leiomyosarcoma and malignant fibrous histiocytoma were the most common tumors (74 per cent). Tumors were completely resected in 42 patients (68 per cent) and incompletely resected in 11, while a biopsy only was performed in 9. Some patients also received adjuvant radiation therapy and/or chemotherapy. There were no long-term survivors among patients with unresectable tumors. Over-all 3 and 5-year survival rates were 68 and 39 per cent, respectively. The histological type of the tumor appeared to have prognostic significance. The highest 5-year survivals were for liposarcoma (70 per cent), malignant fibrous histiocytoma (33 per cent) and leiomyosarcoma (13 per cent). The mean survival for patients after adjuvant radiation therapy or chemotherapy was similar to that after a radical operation alone. The primary cause of treatment failure was local recurrence (45 per cent of the patients), which was detected within 3 years of complete resection in most cases (82 per cent). Complete extirpation that provided adequate margins free of tumor was the most effective initial treatment and provided the best chance for cure.     

Esophageal carcinoma. Improved quality of survival with resection

Twenty years ago the experience with carcinoma of the esophagus at Vanderbilt University and affiliated hospitals was reported in 263 patients. Overall 5-year survival was 2 per cent. Esophagectomy was possible in 89 patients (34%) and was associated with a 32 per cent mortality. This study updates the authors' experience with squamous cell carcinoma of the esophagus in 311 patients seen from 1966 to 1985. Overall 5-year survival has increased to 6 per cent. Esophageal resection was accomplished in 104 patients (33%), with a 10 per cent operative mortality and 41 per cent complication rate. Multi-variant analysis disclosed that smoking, alcohol use, sex, race, and site of tumor did not influence survival. Actuarial survival rates following esophageal resection were 51 per cent at 1 year, 21 per cent at 2 years, and 13 per cent at 5 years. These survival rates were not influenced by adjuvant radiotherapy. Radiation therapy was used for attempted cure in 83 patients. Actuarial survival rates following curative doses of radiation were 29 per cent at 1 year, 15 per cent at 2 years, and 4 per cent at 5 years. These survival rates were significantly (P less than 0.001) lower than survival rates following esophagectomy. The quality of life following treatment was good or fair in 83 per cent of patients undergoing esophagectomy and good or fair in 64 per cent of patients receiving "curative" doses of radiation. The results of this review demonstrate that esophageal resection using the Lewis operation or transhiatal esophagectomy can be done with an acceptable operative mortality, results in prolonged survival, and improves the quality of life.