A twenty-year experience with surgical management of carcinoma of the esophagus and gastric cardia.

Twenty years of experience with operative treatment of carcinoma of the esophagus and cardia are reviewed. Of the 513 patients with biopsy-proved malignancy reviewed, 211 (41%) underwent gastroesophagectomy. The hospital mortality rate for the patients operated upon was 12%. The 3 year survival rate was 26% and the 5 year survival rate was 15% for the entire surgical series. Squamous cell carcinomas of the lower third were the most favorable subgroup (25% 5 year survival) and lower third adenocarcinomas the least favorable (8% 5 year survival). Our procedure of choice is a one-stage resection with stomach used to restore continuity. Operative details and perioperative management are reviewed. The single-layer wire technique of anastomosis seems to give acceptably low rates of anastomotic leak (4.2%) and stricture (2.3%). Preoperative radiation was not used in this series.