Radical Surgery

Radical surgery Surgery is the first-line treatment for cancers of the middle and lower thirds of the esophagus, but it is only possible in approximately 45% of cases and the 5-year survival rate after radical surgery remains low (20% ). Radical surgery may consist of esophagogastric resection via the thoracoabdominal route (right thoracotomy), a transhiatal esophagectomy (left cervical and abdominal approaches without thoracotomy) or esophagectomy by thoracoscopy. Submucosal lymphatic extension leads to sectioning of the esophagus between 5 and 10 cm above the tumor. Operative mortality is not negligible (5%). Palliative treatments -Patients who already present metastases at the time of diagnosis have a life expectancy of 4 to 6 months. Treatments will therefore only aim to reduce dysphagia as much as possible: esophagogastric resection-anastomosis, transtumoral intubation with placement of an endoluminal prosthesis, or laser. Radiotherapy, chemotherapy and combinations -Radiotherapy, alone (effectiveness comparable to that of surgery, but very little effect on the obstructive nature of the tumor) or in combination with chemotherapy (cisplatin), is reserved for inoperable patients. Used alone, chemotherapy reduces tumor volume by 15 to 25% if monochemotherapy, and by 30 to 60% if multichemotherapy. It can be associated with radiotherapy or used pre-operatively (neoadjuvant). Esophageal cancer mainly affects men in their sixties. The main risk factors are alcohol smoking, thermal trauma and certain malformations of the esophagus for squamous cell carcinoma (the most common worldwide), Barrett's ulcer (consequence of chronic gastroesophageal reflux). ) for adenocarcinoma (most common in the United States

United). Of late clinical revelation, its two main manifestations are weight loss and dysphagia (initially with solids, then total). The assessment of esophageal cancer is based, among other things, on esogastroduodenal endoscopy with biopsy and ENT and pulmonary examination (common risk factors).