En Bloc resection

This is a highly controversial area of oesophageal surgery, that involves extensive lymph node dissection for eosphagectomy. Only patients that  are stage 1 (T0-2,N0,M0) or stage II (T0-2,N1,M0 or T3,N0,M0) are suitable. 

For patients with a carcinoma of the cardia or lower third of the oesopahgus an en bloc resection, including lymph nodes from within the upper abdomen and the mediastinum for a distance up to 10cm proximal to the tumour is carried out. Lymph node dissection in the upper mediastinum and neck remains controversial and under evaluation for lower third tumours.

For carcinomas of the mid third of the oesophagus, , a full mediastinal en bloc resection, dissection of the upper abdominal nodes and neck nodes, with a cervical anastomosis is the preferred curative treatment.

For carcinoma of the cervical or thoracic inlet oesophagus, bilateral neck dissections and mediastinal en bloc resection is done. Biopsies of the left gastric and coeliac nodes are included. 

The above procedures are associated with an operative mortality of 10 % and a morbidity of nearly 50%.