The management of esophageal carcinoma is changing but before the introduction of chemotherapy and multidisciplinary teams, surgery became more selective. The aim of this study was to confirm this trend and to examine survival in a total population cohort 1985-94.

Only a quarter of 413 patients had surgery but from 1989 even fewer were operated on but there were more long-term survivors: 1/51 v. 7/58 (p<0.05). Operative mortality fell from 12% to 6.9 % in the later period (N.S.) and survival post surgery was marginally improved, 15 v. 11 months p = 0.0502. The five year survival rate doubled from 7.8% to 17.2%.

Few studies of esophageal cancer include all cases in a defined population. This carries a very poor prognosis but the present cohort shows a slight improvement with more selective surgery and this may serve as a benchmark against which modern multidisciplinary management might be compared.