[Clinical analysis of 34 cases surviving over 10 years after resection of carcinoma of the esophagus or cardia].
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Biomedical subjects
Publications and source records attributed to L T Xu.
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Carcinosarcoma of the esophagus is a rare malignant neoplasm composed of both carcinomatous and sarcomatous elements. Four out of 850 patients with carcinoma of the esophagus or the cardiac portion of the stomach undergoing operation at Capital Hospital, Beijing, had carcinosarcoma of the esophagus. They ranged from 50 to 58 years old, but only 45% of all 850 patients with carcinoma were in the age group from 51 through 60 years old. All 4 patients with carcinosarcoma of the esophagus were men. On barium swallow esophagogram, the 4 patients had a characteristic intraluminal polypoid lesion in the middle third of the esophagus. Such lesions of the esophagus also can occur in patients with benign fibrovascular polyps, leiomyoma, and the polypoid form of esophageal carcinoma and esophageal melanoma. The last two can be differentiated from carcinosarcoma only by pathological examination after excision. After radical excision and esophagogastrostomy, the 4 patients were followed up for 19, 4, 4, and 3 years. They were in good condition without recurrence.
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Until recently, China had been isolated from Western countries for almost 30 years. Surgeons of Western countries, perhaps, are interested to know what is happening in surgery in China. This communication reviews the current interests in Chinese surgery. It is by no means complete, nor is that the intention. The intention is to introduce to our foreign colleagues a general overview of some highlights in Chinese surgery.
From 1961 to 1978, 850 patients with carcinoma of the esophagus or cardiac portion of the stomach were operated on in the Capital Hospital of the Chinese Academy of Medical Sciences. Eighty-three percent of the patients were men, and about 45% of the patients ranged from 51 through 60 years old. Just over half of the patients were seen when the lesion was at a late stage of development. The thirty-day postoperative mortality among 664 patients with a restricted lesion was 10%. Leakage of the esophagogastric anastomosis was the chief cause of morbidity, and about half of the patients with this condition died. The 5-year survival among these 664 patients with a restricted lesion was 22%. Retrospective review of the literature confirmed the possibility of further increasing resectability, further decreasing mortality, and providing greater long-term survival if early complete resection of the tumor can be carried out.
From 1961 to 1979 in Capital Hospital, Peking, China, 27 patients with tracheobronchial tumors were treated: 20 underwent operation and 7 were managed by palliative measures. All 27 patients had an intraluminal lesion of the trachea or major bronchi. Respiratory obstruction was the main clinical manifestation of the tracheal tumors. Chronic suppurative infection of the lung was the principal clinical manifestation of the bronchial tumors. Histological diagnosis of these 27 patients revealed ten different cell types: squamous cell carcinoma (10 patients, including the 7 who did not undergo operation); adenoid cystic carcinoma (5 patients); carcinoid, hamartoma, neurofibroma, and papilloma (2 patients each, respectively); and leiomyoma, hemangioma, chondroma, and teratoma (1 each, respectively). The operative methods used in 20 patients were lateral resection of tracheal wall (2 patients), resection of left main bronchial root (1), local excision (5), lobectomy (5), pneumonectomy (3), bronchoscopy (1), and exploratory operation and tracheostomy (3). Local excision or lateral wall resection of the trachea was chosen for benign or less dangerously malignant tracheal tumors. Lobectomy or pneumonectomy was performed for the secondarily infected, destroyed lungs in patients with bronchial tumors.
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From 1961 to 1972, 123 patients with lung cancer underwent operations at Capital Hospital, Peking, China. Ninety-six patients had resectable lesions and 27 did not, a resectability rate of 78%. Four patients (4.2%) died immediately postoperatively. Complications occurred in 8 (8.3%) patients. Five-year survival in this group of 92 survivors was 26 (28.3%). Ten-year survival among 49 patients was 10 (20.4%). Among the 92 five-year survivors, 41.2% had squamous cell carcinoma, 25% had adenocarcinoma, and 16% had undifferentiated carcinoma. Patients with squamous cell carcinoma had a much longer survival than the others. Six factors appear to influence survival after resection: cell type, presence of lymph node metastases, presence of tumor emboli in blood vessels, sex, age, and location. Men about 50 years of age, with a peripherally located squamous cell tumor and with no tumor emboli or lymph node metastases, have a good chance of surviving a pulmonary resection for ten years.
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