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Extensive long segment resection for carcinoma of the esophagus including also consequent mediastinal and celiac lymph node dissection is able to achieve satisfactory radicality only in early tumor stages while there is little influence on long term prognosis for advanced tumor stages. Only better risk analyses and improved surgical outcome with reduced operative mortality has improved the overall outcome. In locally limited primary tumors and even more in locally advanced stages generalisation or dissemination of tumor disease is to be expected. Therefore it is generally agreed upon that only multimodal therapy including systemic chemotherapy and local radiotherapy is able to improve therapeutic results in this disease with otherwise very poor prognosis. We report our own experience on 200 esophageal resections including modification of our strategy and protocol presently in use for tumor stages IIB to IV.

In each histological subtype of a primary gastric non-Hodgkin lymphoma laparotomy is performed with the intention of an R0 resection. This concept appears to be rather aggressive if you take into account the possibilities of the other treatment modalities; however, because of the diagnostic uncertainty and of the changing histologic classifications there is an uncertainty about the character and the dissemination of the tumor. Consequently total gastrectomy with systematic lymphadenectomy provides enough basic informations to plan multimodal therapeutic concepts and their clinical evaluations.