Which of the following statements about the surgical treatment of esophageal carcinoma is/are correct?

C. The morbidity and mortality rates for cervical esophagogastric anastomotic leak are substantially less than those associated with intrathoracic esophagogastric anastomotic leak.

DISCUSSION: Severe dysplasia in Barrett's mucosa is indicative of carcinoma in situ and is an indication for resectional therapy, not an antireflux operation. In the majority of patients, local tumor invasion or distant metastases preclude cure when esophageal carcinoma is diagnosed, and attempts to improve survival with a more radical local operation performed in the face of systemic disease have been disappointingly futile. A cervical esophagogastric anastomotic leak causes a relatively minor cervical salivary fistula that heals in 7 to 10 days in 95% of patients. In contrast, an intrathoracic esophagogastric anastomotic leak results in mediastinitis, which is fatal in 50%. The leading complications of transthoracic esophagectomy and an intrathoracic esophagogastric anastomosis are respiratory insufficiency (from combined thoracic and abdominal incisions) and anastomotic leak resulting in mediastinitis and sepsis. Both complications are minimized by transhiatal esophagectomy without thoracotomy plus cervical esophagogastric anastomosis. No single operative approach to the treatment of esophageal cancer has proved superior to others in terms of long-term survival. The biologic behavior of the tumor (its stage and aggressiveness)—not the number of lymph nodes resected with the tumor—determines surviv