Summary: During the years from 1986 to 1992, at the Second Department of Surgery in Olomouc, 76 patients with malignant tumors of the esophagus were examined. All of them were subjected to complex preoperative examinations on the basis of which the state of the disease and the therapeutical tactics were determined. We evaluated the anamnestic data, the results of contrast x-ray examinations, computer tomographies, endoscopies with biopsies, ultrasonographies, endosonographies as well as the results of the laboratory, immunological, internal and pneumo-logical investigations. During the preoperative assessment of the operability, a great contribution have shown to be some modern diagnostic method, especially computer tomography (CT) and endosonography. Of the total of 55 examined patients (72 %), in 8 of them (1.43 %) significant discrepancies were found between the result of the preoperative C T examination and the surgical finding. Three times metastatically involved lymph nodes of the size up to 1.5 cm were not found, twice in the mediastinum and once under the diaphragm. Five times infiltration of the tumor into the bronchus, the aorta and the backbone was not demonstrated. An erroneously positive CT result was recorded twice when infiltration into the aorta was described which was excluded during surgery. So far, the endosonographic examination shows to be still more accurate than computer tomography. We examined 72% of the patients who were indicated for radical surgery during the past year. Contrary to CT, endosonography revealed on the one hand unrecognized infiltration into the surrounding or the presence of lymphnodes, on the other hand it informed us twice correctly of the favourable demarcation against the surrounding. Up till now, we have not encountered differences between the endosonographic results and the praeoperative findings. Our diagnostic conclusions were based on the TNM classification. In wiew of the preoperative staging, 54 patients (71%) were indicated to surgery. The total peroperative mortality amounted 18.5 %. Twentysix patients (34.2%) were radically operated on, twentyfour palliatively, and in four patients only exploration was performed. In 22 patients (28.9%), after the assessment of the general state and the extent of the tumorous disease, we left off operating, some of these patients were then indicated to actinotherapy.
The general diagnostics and strategy of the surgical treatment of esophagus carcinoma
