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HISTORY

Historically, surgery is the mainstay of treatment for esophageal cancer. Czerny was the first who resected a cervical esophageal cancer in 1877. In 1913, Torek performed the first transthoracic esophageal cancer resection successfully.1 A rubber tube was used as the esophageal substitute connecting the esophagostomy and gastrostomy for feeding in the patient, who lived for another 17 years. Reconstruction using stomach as a conduit after intrathoracic esophageal cancer resection was performed by Ohsawa, a Japanese surgeon in Kyoto, in 1933.2 In 1946, Lewis described a 2-phase approach via right thoracotomy and laparotomy.3 Tanner reported the same procedure in 1947.4 McKeown later described the 3-phase esophagectomy via right thoracotomy, laparotomy, and cervical incision.5

In addition to surgical treatment, there has been a proliferation of treatment options, especially with regard to different combinations of chemotherapeutic agents and radiotherapy, in the past 2 decades. Significant divergence in the epidemiologic pattern between Western and Eastern countries has been observed, which has had a major impact on the management of this disease.

EPIDEMIOLOGY

Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of death from cancer.6 There is significant variation of incidence among different geographic regions and various ethnic groups. The disease is common in countries of the so-called “Asian esophageal cancer belt,” which stretches from eastern Turkey and east of Caspian Sea through northern Iran, northern Afghanistan, and southern areas of the former Soviet Union, such as Turkmenistan, Uzbekistan, and Tajikistan, to northern China and India. In high incidence areas, the occurrence of esophageal cancer is 50- to 100-fold higher than that in the rest of the world. It is the fourth most common cancer in China.7 The age-standardized incidence rate of esophageal cancer in China is 27.4 per 100,000, compared to 10 in Japan, 7.9 in northern Europe, 7.6 in western Europe, 5.8 in North America, and 5.5 in Australia/New Zealand.6 The crude age-adjusted mortality is up to 140 per 100,000, and esophageal cancer is the one of the most common causes of cancer death in China.8 Esophageal cancer most commonly presents in the sixth and seventh decades of life. In most countries, esophageal cancer is a male-predominant disease.

Over the past three decades, there has been an epidemiologic shift from squamous cell cancers to adenocarcinoma of the lower esophagus and cardia in the white populations in Western countries. The incidence of adenocarcinoma has surpassed that of squamous cell cancers since the 1990s. In Eastern countries, however, squamous cell cancer remains the predominant type and is mostly located in the mid esophagus.

ETIOLOGY

The etiologic factors for the development of esophageal cancer vary between the different histologies (Table 26-1). Smoking and drinking are independent contributing factors, as shown by prospective studies of patient who drink but do not ...

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