M0 M0 M1

FIGURE 11.3 (A) Endoscopic view of EAC in the thoracic esophagus seen as a multilobed ulcerated mass; (B) Endoscopic ultrasound showing the same lesion as a hypoechoic mass (labeled T). (Pictures courtesy of Dayna Early, MD, Washington University School of Medicine, St. Louis, MO.)

without dilation, may be an appropriate compromise.23 Because appropriate treatment for esophageal carcinoma depends on accurate staging, EUS plays a pivotal role in the development of appropriate therapy.

It is also important that the patient have sufficient physiologic reserve and remain compliant in order to undergo such a major surgical procedure with substantial morbidity and mortality. Composite scores, which take into account the patient's general status, cardiac function, hepatic function, and respiratory function, have been used, and the result has been a reduction of postoperative mortality from 10% before 1990 to 2% since

1994.22

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