Cliniques universitaires Saint-Luc

Upper Gastrointestinal Surgery Unit

CANCER OF THE ESOPHAGUS

Cancer of the esophagus results from either chronic alcohol and/or tobacco consumption (squamous cell carcinoma) or chronic exposure of the esophageal mucosa to gastric contents (Barrett's adenocarcinoma).

In patients having a good general condition and without any evidence of distant metastases or invasion of the immediately adjacent organs before or during the operation, resection of the esophagus en-bloc with the potentially invaded loco-regional lymph nodes is the mainstay of treatment

  

This operation provides those eligible patients with a chance at a long-term favorable outcome as follows:

  

• Normal lymph nodes in the resected specimen:
  64% survival rate 5 years after the operation.
• Fewer than 5 invaded lymph nodes in the resected specimen:
  43 % survival rate 5 years after the operation.
• 5 or more than 5 invaded lymph nodes in the resected specimen:
  11 % survival rate 5 years after the operation.

Those patients with a huge tumor located in the proximal half of the esophagus are candidates for induction radiochemotherapy in order to downstage the tumor and make en-bloc resection of the esophagus feasible.

Patients who are not eligible for an en-bloc resection are treated by a more limited (surgical or endoscopic) resection, radio-chemotherapy, curietherapy, endoprosthesis, endoscopic dilatation, endoscopic laser therapy, and/or jejunostomy.

Some early lesions can be treated by endoscopic mucosal resection if there is no endosonographic suspicion of submucosal spread at initial work-up. No subsequent esophagectomy is needed in the absence of any invasion of the submucosa at histologic examination of the resected specimen.

Each clinical case is discussed at a bi-monthlymultidisciplinary meeting gathering surgeons, medical gastro-enterologists, radiotherapists, medical oncologists, radiologists, anaesthesiologists, intensive care physicians and histo-pathologists in order to provide each patient with the most relevant treatment.