Preoperative tests: Test of cardiovascular system function - ECG, in some justified cases echocardiography, exercise test, arteriography of carotid artery, Doppler's USG of carotid arteries. Test of respiratory system function - spirometrical and gasometrical tests; assessment of vital lung capacity, one-second tense tidal volume, Tiffeneau-test. Kidneys and liver function test determination of urea level, creatinine, creatinine clearance, level of sodium, potassium, chloride and calcium ions, level of transaminases GOT, GPT, bilirubin, alkaline phosphatase, hepatic tests. Determination of the complete albumin level and albumin found in plasma. Assessment of the degree of undernourishment and dehydration assessment of the thickness of a skin fold, Determination of the general state of a patient scales of Karnofsky and WHO.

Qualification to operation: General state according to Karnofsky's scale at least 80, according to WHO - not more than 1. Normal functioning of bone marrow (RBC 3.5 mln/1ml, PLT 100thous/1ml). Normal functioning of kidneys (indicator/gauge of creatinine clearance >50l l/min). No remote metastases (M0). Treatment

Surgery

Surgery usually consists in a removal of the tumour together with a part or the whole of the oesophagus and surrounding lymph nodes and tissues. Then, the remaining part of the oesophagus is joined to the stomach in the cervical area in order to preserve swallowing ability. Sometimes, endoprostheses are used, however, usually only of stomach or intestine . An additional joint of the stomach directly to the intestine may be carried out in order to facilitate passage of food from the stomach to the intestine. It should be remembered that this type of surgery depends mainly on the general state of a patient and the stage of cancer development.

Main methods used in surgery are presented below:

Transhiatal esophagectomy (m. Orringer). 1. Upper part of abdomen and lower part of neck are opened, no direct invasion in the chest. 2. Oesophagus is dissected with care from mediastinal structures and then removed. 3. Subsequently, stomach is connected with the cervical part of the oesophagus (end-to-end esophagogastrostomy) carried in the site of anterior mediastinum. Transmediastinal esophagectomy (m. Akiyama). 1. Chest is opened on the left and right side (more often on the right side, with the tumour in the upper and middle part of the oesophagus, and taking into consideration the aortic arch; more often on the left if the tumour is localized in the joint of the oesophagus and the stomach). 2. Incision in the sixth left intercostal area exposes anterior mediastinum. 3. Semicircular incision of the diaphragm, 1 inch from the costal arch, exposes upper part of abdomen. 4. Oesophagus is removed with perioesophageal nodes and nodes of lesser curvature of the stomach 5. Substitute is made mainly from stomach: a) with incision made on the right side, laparotomy is additionally performed in order to prepare stomach and to place in the site in the anterior mediastinum or in the retrosternal area, b) with incision made on the left side, stomach is pulled under the aortic arch and joined to cervical stump of the oesophagus. Esophagectomy en bloc. 1. It consists in excision of the tumour with a wide margin including surrounding structures in the background together with pleura and with pericardium in front. 2. Lymphatic vessels placed between the oesophagus, aorta and thoracic duct are excised en bloc. 3. Anterior mediastinum excision guarantees complete removal of nodes from the split of trachea to oesophageal hiatus. 4. Hepatic, visceral, left gastric nodes and nodes of lesser curvature of the stomach, parahiatal and retroperitoneal, which reduces the number of local post operational metastases to less than 10%. Esophagectomy en bloc with tripolar lymphadenectomy It consists in additional excision of cervical nodes.

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