[Surgical approach in the management of oesophageal tumours: considerations based on therapeutic results].

Over the last two decades, oesophageal cancers, although considered among the most malignant visceral tumours, have witnessed a gradual increase in survival rates at a distance after surgery. The aims of the study were to present the results of our surgical approach and, on this basis, to discuss a number of considerations regarding the type of intervention to be adopted. In a retrospective study we recruited 105 patients with oesophageal cancer treated with various types of oesophageal resection, with or without thoracotomy, in the Division of General Surgery of the Civic Hospital of Sondrio. The postoperative mortality rate was 12%, with 40.2% of non-lethal complications. The average overall survival, whether in patients R0 or not, was 31.2 months (range: 1-167), with actuarial survival rates of 63.2% at one year, 30.3% at three years and 22.1% at five years. This was not significantly influenced by the type of surgery or by the location or histology of the cancer, while TNM stage, degree of parietal infiltration and the presence or absence of lymph-node metastases were significant factors. Although we limited the lymphadenectomy to "standard or extended two-field" operations, our overall survival at five years was similar to that of surgeons advocating much more extensive lymphadenectomy. In our case most of the relapses occurred at the systemic level and in the short term, on average after 12.7 months, meaning that micrometastases were probably already present at the time of intervention (82.4% of these patients, in fact, had stage N1 cancers). We prefer cervical anastomosis owing to the possibility it affords of greater oesophageal resection and to its relative safety in case of dehiscence. We always perform a right cervicotomy, which allows us to avoid having to move the patient on the operating table and to have fewer injuries to the recurrent nerve.