Barbier P, Joss R, Scheurer U, Aeberhard P
Schweiz Med Wochenschr. 1982 Jul 17;112(29):1026-32.
In Europe, carcinoma of the esophagus is a relatively rare disease with an annual mortality rate of 4-7 deaths per 105 inhabitants. Institution of appropriate therapy for esophageal carcinoma depends mainly on accurate diagnosis and staging. Computed tomography displays the anatomy of the esophagus and mediastinum with a high degree of accuracy and is a good method of assessing extra-esophageal spread of carcinoma. Preoperative nutritional support may reduce operative mortality and morbidity in high-risk patients. Today there is still no alternative to resection of the carcinoma. Esophagogastrectomy with (cervical) esophagogastrostomy with or without thoracotomy is the treatment of choice for patients with squamous cell carcinoma of the esophagus. Prognosis is still poor, with a 5-year survival rate of less than 20%. If resection is technically impossible, an endoesophageal tube can be inserted or a bypass procedure carried out to increase the quality of life with near normal ability to swallow. Radiotherapy can be used when surgery primarily is not applicable for medical reasons or is refused. Preoperative radiotherapy does not produce statistically significant short- or long-term benefit in the management of esophageal squamous cell carcinoma. Chemotherapy or combination chemotherapy have so far been insufficiently tested and cannot be recommended today for routine use. A combined modality approach is promising but needs further evaluation.
在欧洲，食管癌是一种相对罕见的疾病，年死亡率为每10万居民中有4至7人死亡。食管癌的恰当治疗主要取决于准确的诊断和分期。计算机断层扫描能高度准确地显示食管和纵隔的解剖结构，是评估癌肿食管外扩散的一种好方法。术前营养支持可降低高危患者的手术死亡率和发病率。目前，切除癌肿仍然是唯一的治疗方法。食管胃切除术加（颈部）食管胃吻合术，无论是否开胸，都是食管鳞状细胞癌患者的首选治疗方法。预后仍然很差，5年生存率不到20%。如果技术上无法进行切除，可以插入食管内管或实施旁路手术，以在吞咽能力接近正常的情况下提高生活质量。当手术因医学原因主要不适用或被拒绝时，可使用放疗。术前放疗在食管鳞状细胞癌的治疗中未产生统计学上显著的短期或长期益处。化疗或联合化疗迄今尚未得到充分测试，目前不能推荐用于常规治疗。综合治疗方法很有前景，但需要进一步评估。
