Surgery for clinical T3 carcinomas of the upper thoracic oesophagus and the need for new strategies

Abstract

Patients with T3 carcinomas have a dismal prognosis, even after complete resection of the primary tumour and metastatic nodes. This study focused on the clinicopathological characteristics and outcomes after surgical resection of clinical T3 carcinomas of the upper thoracic oesophagus. Between January 1988 and February 2000, 888 consecutive patients underwent surgical removal of carcinomas of the thoracic oesophagus or oesophagogastric junction at the National Cancer Centre Hospital, Japan. The case records of 51 consecutive patients with clinical T3 tumours of the upper thoracic oesophagus were analysed retrospectively. No patient received preoperative therapy. Complications occurred in 41 (80 per cent). In-hospital and 30-day postoperative mortality rates were 10 and 4 per cent respectively. Gross residual primary tumour or metastasis in regional nodes invading adjacent structures was noted in 14 patients (27 per cent) and incomplete resection including microscopic residual tumour in 23 (45 per cent). Overall 3- and 5-year survival rates were 20 and 12 per cent; median survival was 13.1 months. Surgical resection of clinical T3 carcinomas of the upper thoracic oesophagus is associated with a high postoperative complication rate, incomplete resection and unsatisfactory outcome. Reconsideration of the surgical treatment strategy for these tumours is needed.