Diagnosis and Treatment of Carcinoma of the Esophagus

¹ The Department of Surgery, University of Illinois, Cook County Graduate School of Medicine, Cook County Hospital, American Hospital and Alexian Brothers' Hospital.

1) A zoning of the esophagus into three divisions has proved helpful and practical as an aid to standardizing the surgical treatment for carcinoma of the esophagus, and has been applied in a personal series of 71 cases.

2) Typical case histories of Zone 2 and Zone 3 lesions and their surgical management have been cited.

3) Lesions involving Zone 2 (midthoracic esophagus) are best treated by transthoracic partial esophagectomy and partial gastrectomy with a supra-aortic esophagogastric anastomosis.

4) Zone 3 lesions (lower esophagus and cardiac end of the stomach) are best resected by a combined thoracolaparotomy incision which does not necessitate the removal of any rib or ribs.

5) A modification of the standard incisions is suggested.

6) With the advent of positive pressure anesthesia in the hands of qualified anesthetists, chemotherapeutic agents, expert pre- and postoperative care, and the perfection of surgical technic, such extirpations are made possible, thus providing a new lease on life for these patients who only a few years ago were considered doomed.