Improved results of surgery for esophageal carcinoma in 148 patients.

Since the late 1970's, there has been a remarkable decrease in the mortality of patients with esophageal cancer. Factors such as progress in pre- and post-operative management, operative technique, and anesthesia all play a contributory role in this improvement. Among 251 Japanese patients with esophageal carcinoma who underwent esophageal resection and reconstruction in our department of surgery since 1965, those treated from 1965-74 and others treated from 1975-1984 were investigated in detail. It became clear that pulmonary complications and anastomotic leakage were the two major complications related to operative mortality. The former has decreased by intensive postoperative care with strong emphasis on cough dynamics, and the latter because of the long gastric tube we devised and which has a good blood supply. These positive events make feasible early postoperative irradiation and cancer chemotherapy.