Between June 1988 and June 1994, twenty five patients with locally advanced esophageal carcinoma received preoperative chemotherapy(Cisplatin, 5-Fluorouracil with or without Etoposide) and followed by resection. All patients had clinical evidence
of
airway involvement or distant lymphnode involvement(M1 1ymphnode) on bronchoscopy or computed tomographic scans. The major response rate to chemotherapy decided by the postoperative stage was 48%(12/25). The resection rate was 92%(23/25) with
overall
complete resection rate of 72%(18/25). Two patients had exploratory laparotomy(thoracotomy) only. Thirteen patients had esophagogastrostomy with a combined abdominl and Rt. Thoracic approach(Ivor Lewis operation), six patients had transhiatal
esophagectomy, four patients had esophagogastrostomy with a combined Rt. Thoracotomy & abdominal, cervical approach. There were three postoperative deaths(12%).
Follow-up duration was between 3.3 months to 65 months. Median survival time of resected patients except hospital death was 14.8 months. Actuarial survival at 12, 24 months was 72.9%, 26.2%. Significant better survival was associated with
responder
group(postoperative stage less than IIB)(P=0.029).
These results demonstrate that 1) Preoperative Cisplatin based combined chemotherapy produce high response rate, 2) High complete resection rate with acceptable mortality rate occur after preoperative chemotherapy, 3) Better survival can be
anticipated
if complete resection performed after major response to preoperative chemotherapy.
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