Colon substitution for radical treatment of cardia and lower third esophageal cancer.

During the past 24 years we have treated 786 patients with esophageal and cardia carcinoma. En bloc resection of the tumor has been performed in only 461 (65.2%) of them and in 246 (34.7%) of the cases various palliative operations have been undertaken. Most of the patients were in stage II or III of the disease with squamous cell carcinoma in 80.5% and adenocarcinoma in 19.5% of them. The method of choice for the treatment of the patients with cardia and lower third of the esophagus carcinoma (n - 315) were blunt esophagectomy followed by colon (n - 256), stomach (n - 54) and/or jejunal (n - 9) substitution. The histology results confirmed the oncologic radical zone of resection of the esophagus from 8 cm above the tumor to 10-12 cm below in the stomach wall. This is the reason why substitution of the esophagus with stomach tube is very often impossible and the colon substitution remains the method of choice for such patients. The other important factor is radical resection of the tumor with the surrounding tissue, organs and lymph nodes involved (resection en bloc). The hospital mortality included 28 patients (7.3%) from the radically operated who also underwent esophageal substitution (n = 378). For these patients the 3-year survival rate is 51% (n - 191) and 5-year survival 46% (n - 172).