One of the earliest descriptions of esophageal cancer was in the second century ad, when Galen described a fleshy obstructing growth in the esophagus, which was responsible for the inability to swallow and led to emaciation and death. In early Chinese literature, a patient who had esophageal cancer was described as “one suffers in autumn, and does not live to see the coming summer.” Improvement in treatment strategies has resulted in better outcome. However, most patients are still diagnosed at an advanced disease stage, with consequent poor prognosis. In 1877, Czerny was the first to successfully resect a cervical esophageal cancer and the patient lived for 15 months. Torek in 1913 performed the first successful transthoracic resection.1 A 67-year-old woman had a squamous cell cancer of the midesophagus. Through a left thoracotomy, the esophagus was resected. The proximal cervical esophagus was brought out through an incision anterior to the sternocleidomastoid muscle and tunneled subcutaneously along the anterior chest wall, where a cutaneous esophagostomy was fashioned. The patient was fed via a rubber tube connecting the esophagostomy with a gastrostomy. The patient lived for 17 years.
The first successful resection of a thoracic esophageal cancer with reconstruction using the stomach was performed by Ohsawa, a Japanese surgeon in Kyoto, who reported the technique in 18 patients in 1933.2 In 1946, Lewis described esophageal resection using a two-phase approach via a right thoracotomy and laparotomy.3 Tanner independently also described the procedure in 1947.4
Although surgical resection has remained the mainstay treatment for esophageal cancer, recent years have seen a proliferation of treatment options especially with regards to different combinations of chemotherapeutic agents, radiotherapy and surgery. There has also been a divergence in the epidemiological pattern between Western and Eastern countries, which has made a major impact on the management of this disease.
Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of death from cancer.5 There is marked geographic variation in the incidence of cancer of the esophagus and, to some extent, among different ethnic groups within a common area. The disease is especially common in countries of the so-called “Asian esophageal cancer belt,” which stretches from eastern Turkey and east of the 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. High incidences are also found, in the Transkei province of South Africa and Kenya. 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.6 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 and 7.6 in western Europe, 5.8 in North America, and 5.5 in Australia/New Zealand.5 The provinces of Henan, Hebei, Shanxi in ...