What kind of surgical radicality is justified in the treatment of esophageal and esophago-gastric junction tumours?

In the period from January 1, 1973 to November 30,1994, a total number of 1856 patients had been admitted to our Department of Surgery because of cancer of the esophagus and esophago-gastric junction. We divided our activities into two study periods. In the first study period from 1973 to 1984 only so called "conventional operations" were performed. Since 1985 new oncological aspects were introduced into our operative tactics: 1. the subtotal esophagectomy combined with the two-field lymphadenectomy, 2. the total gastrectomy with extended lymph node dissection. The analysis of our results with respect to the survival parameters (TNM staging, histological type, grade of differentiation, gross pathology) showed that the best chances were obtained by curative resection and lymphadenectomy in tumours of low-grade biologic malignancy. In esophageal cancers the former 6% 5-year cumulative survival rate increased to 26%, and in cardia tumours from 9 to 27%, because of enhancement of radicality and extension of lymphadenectomy.