Abstract

Of all the malignant lesions of the gastrointestinal tract, cancer of the esophagus is among the most difficult to manage. Although it has fairly typical presenting clinical features in the form of an elderly patient with dysphagia; the subsequent investigations have to be fine-tuned to select which patient should undergo esophageal resection (a formidable procedure which carries a high mortality risk and is associated with serious complications), who should undergo neoadjuvant therapy and who should only be palliated with stents or chemoradiotherapy. In recent years this fine-tuning has become much more precise with many patients being saved from harmful explorations of the chest and abdomen only to encounter widespread disease and at the same time many who have large, locally invasive tumors which were thought to be unresectable being given neoadjuvant chemotherapy and subsequently being able, sometimes, to undergo curative esophagectomy. Possibly because of these improvements in diagnosis and multimodality treatment, the 5-year survival of patients with esophageal cancer that has been resected has improved from a dismal 5%, 15 years ago to a more respectable 25% now. In this book, authors, two thirds of whom are from the Memorial Sloan-Kettering Cancer Center (MSKCC) in New York, have evaluated the published evidence on different aspects of the management of patients with esophageal cancer as well as made recommendations from their own experience with the disease. Thus, we have chapters on diagnostic and therapeutic endoscopy, staging, perioperative therapy, operative treatment (transhiatal, radical, Ivor Lewis and the minimally invasive approaches) and postoperative complications. Finally there is a chapter discussing the epidemiology and difficulties in the management of patients with esophageal cancer in India where the disease is common and mainly affects poor people who cannot afford expensive treatment. The author mainly discusses the experience of the Tata Memorial Hospital in Mumbai where every year 1200 patients are seen with the disease and 180 undergo surgery. This is amongst the largest experience of the treatment of patients with esophageal cancer worldwide. All the subjects and authors have been brought together for this volume by the Editor, Manjit Singh Bains, who is a Professor of Clinical Cardiothoracic Surgery at the Cornell Weill Medical College in New York as well as an Attending Thoracic Surgeon at the MSKCC.