In an effort to improve survival following esophageal resection, trials of multi-modality therapy in combination with surgery have been completed. Which of the following statement(s) is/are true concerning such treatment?

b. No residual carcinoma may be found in the resected specimen in up to 20% of patients

c. Nonrandomized trials would suggest improved survival compared to patients receiving surgery alone

Combined preoperative chemotherapy and radiation therapy before transhiatal esophagectomy for carcinoma has provided encouraging survival statistics. The treatment consists of preoperative chemotherapy with three weeks of cisplatin, vinblastine, and 5-fluorouracil, concurrent with 3750 to 4500 cGy of radiation therapy. Although hematologic toxicity and radiation esophagitis are common and preoperative deaths due to bone marrow suppression can occur, there is no increase in perioperative morbidity when compared to patients with no preoperative therapy. In one study, 24% of patients had no residual carcinoma in the resected specimen (T0, N0 status). At mean follow-up of 36 months, the mean survival in this series was 29 months, a clear improvement over the 12-month median survival time with transhiatal esophagectomy alone in historical controls.