Topical issues of esophageal cancer and gastroesophageal cancer surgery

Abstract

Background. Esophageal cancer (MS) ranks 14th in the structure of can­cer in the population of Ukraine. Gastroesophageal cancer (GER) is sev­eral times more common. It is estimated that cancer in this area accounts for more than 20 % of all stomach cancers. The results of cancer treatment in this location are the worst among other cancers. This is due to high ne­glect in newly diagnosed patients, high postoperative mortality (15 %) and low five-year survival. Purpose. To analyze the literature sources related to esophageal cancer and gastroesophageal cancer surgery development in chronological terms and to define the main directions for further development of surgery of this pathology. Materials and methods. The literature review has involved available full-text contributions obtained via literature search in domestic and for­eign databases. The search was restricted to the studies published within the 1975–2020 timeframe. Special emphasis was placed on the effectiveness analysis of lymph node dissection and methods of esophagogastric anastomosis forming, in a comparative aspect. The paper also analyzes the materials of the authors’ own long-term studies related to this issue. From 1990 to 2018, 250 pa­tients with esophageal cancer and gastroesophageal cancer were treated at SO «IMR of the NAMS of Ukraine» and the regional clinical oncology dispensary. Results and discussion. Literature suggests that the failure of the esopha­geal-gastric anastomosis is secondary among complications. Cardiovascu­lar and pulmonary complications come first. When performing 3-zone lymph dissection increases five-year survival by 10 %. The inability of the esophagogastric anastomosis in leading clinics is from 3 to 9 %. Performing a plastic esophagogastric anastomosis in­creases its physiological properties. Conclusions. Thus, surgical treatment remains the main strategic direc­tion in the treatment of MS and GER. The primary goal of treatment is the survival of patients. Data from literature sources indicate the need for mandatory mediastinal and abdominal lymph dissection. The most successful results of treatment of esophageal cancer and gastroesophageal cancer were obtained in lead­ing specialized oncology clinics where the lowest postoperative mortality is observed. Treatment of cancer in this location requires the use of adju­vant treatments (chemotherapy and radiation therapy).