Thoracic esophageal carcinoma above the carina: a more formidable adversary?

Background: Prognosis with esophageal carcinoma above the carina is generally thought to be the worst without any conclusive demonstration.

Methods: Clinicopathologic features of 101 patients with thoracic esophageal carcinoma above the carina (AC group) were compared with those of 665 patients with a tumor below this level (BC group).

Results: The number of T4 tumor was significantly larger in the AC group (P < 0.001). Survival curve for all patients in the AC group was significantly worse than the BC group (P < 0.001). Survival in patients who underwent any treatment other than esophagectomy was equally bad in the two groups. However, survival in patients undergoing esophagectomy was similar in the two groups (P = 0.64), with the cumulative 5-year survival rates of 44.5% and 43.1%, respectively. Even in patients with metastatic disease in the lymph nodes, the cumulative 5-year survival rates after radical esophagectomy were similar.

Conclusions: The prognosis of patients in the AC group is generally worse than the BC group because of the close anatomical relationship with the tracheobronchial tree. However, radical esophagectomy is recommended for patients at stages less advanced than T4.