Pretreatment Laparotomy

The primary cancer is the major obstacle to cure in cancer of the esophagus. In most series, the reported survival figures with present methods are 1% to 5% if all patients are included. The effect of regional lymph node involvement on survival could be appraised more realistically if local ablation was achieved. The basic rule in treatment of alimentary tract cancers is resection of the primary cancer with wide margins, and en bloc nodal resections. Although this approach is feasible with abdominal viscera in the stomach and colon, the lymphatic drainage of the esophagus is too dispersed to permit it. The lymph node echelons at risk in esophageal cancer include the cervical, supraclavicular, posterior mediastinal, retrotracheal, cardiac, and those of the lesser curvature regions. The abundant submucosal communications allow for rapid spread via peristaltic activity in the longitudinal axis of the esophagus; this communication system renders all nodal stations at