A 65-year-old patient has a carcinoma of the esophagus at the level of the sternal notch. There are no palpable lymph nodes in the neck. The appropriate management of this patient is
|B||Combination chemotherapy and radiation therapy|
|C||Preoperative radiation therapy and surgical resection|
a. When considering resection, tumors of the esophagus are best divided into those above and those below the carina.
b. The difference between the two forms of therapy is the manner in which the disease recurs.
c. Tumors treated with radiation therapy initially tend to recur locally as well as systemically, and cause unmanageable local disease with eventual erosion into neck vessels and trachea, causing hemorrhage and dyspnea.
d. Patients who undergo surgical therapy have few local recurrences of the tumor, provided total excision is possible, but they succumb to metastatic disease.
e. The thoracic esophagus is removed via a right posterolateral thoracotomy with a corresponding en bloc lymphadenectomy. The continuity of the gastrointestinal tract is re-established by pulling the stomach up through the esophageal bed.
f. A bipedicle skin flap over the pectoralis muscle can be advanced upward, or a single-pedicle musculocutaneous flap including the pectoralis muscle and its overlying skin can be rotated to cover the defect.