Changes

==Treatment==

==Treatment==

===Surgical Management===

===Surgical Management===

Complete tumour excision with oesophageal anastomosis is frequently problematic due to difficulties obtaining complete margins and complications of reconstruction. There can also be complications in the healing of particularly the thoracic oesophagus. One study of 6 dogs who underwent partial oesophagectomy due to Spirocerca-related oeophageal sarcomas reported a median survival of 267 days. 5 of the 6 cases also received doxorubcin. Another study of 4 dogs with oesophageal leiomyosarcoma reported potential long term resolution of clinical signs following marginal surgical resection despite incomplete margins if the tumour was low grade (all were grade 1). Oesophageal bouginage can reduce signs such as regurgitation. Oesophagotomy and gastrostomy tubes can also be used for short term palliation.

Due to the advanced development of many oesophageal neoplasms at the time of diagnosis, complete surgical excision is often problematic.  The thoracic oesophagus may be approached by lateral thoracotomy on either side (retracting the brachiocephalic trunk if approaching from the left or ligating the azygos vein if from the right) or via a median sternotomy.  The affected portion of the oesophagus is isolated with loops of moist umbilical tape and moist laparotomy swabs are used to pack the oesopahgus off from the thorax.  The tumour is excised, together with the largest possible margin of normal tissue and an anastomosis is then created between the two ends of the incision. 

 

Only 3-5 cm of the length of the oesophageal can be resected without risking dehiscence of the anastomosis and it is advisable to restrain the patient in a headcollar and side-reins after the procedure to prevent this site from coming under tension.  The oesophagus is especially prone to dehiscence because it is under constant tension (exacerbated by movement) and because it lacks a serosa which is responsible for the formation of an initial fibrin seal during healing of the rest of the gastro-intestinal tract. To support a large resection, intercostal muscle flaps, omentum or synthetic meshes can be wrapped around an anastomotic site.  Tension on the oesophagus can also be released by sectioning the phrenico-oesophageal membrane (which attaches it to the diaphragm) or by making a circumferential incision through the outer longitudinal muscle layer.  Dehiscence of a surgical wound is one cause of [[Rupture of the Oesophagus|oesophageal rupture]].  Bougeinage may be used to prevent the formation of [[Oesophageal Stricture|strictures]] at the surgical site.  Gastrostomy tubes can be used for short-term palliation of cases with extensive tumours that have obliterated the oesophageal lumen.

 

One study of 6 dogs that underwent partial oesophagectomy for treatment of ''S. lupi''-related oeophageal sarcomas reported a median survival of 267 days with adjunctive doxorubicin therapy. Another study of 4 dogs with oesophageal leiomyosarcoma reported potential long term resolution of clinical signs following surgical resection (despite incomplete margins) if the tumour was of a low histological grade (all those in the study were of grade 1).

===Chemotherapy===

===Chemotherapy===

===Radiotherpy===

===Radiotherpy===

There is little opportunity to use this technique for oesophageal neoplasia as the surrounding organs (the heart and lungs) have a poor tolerance to radiation.  [[Oesophagitis]] and [[Oesophageal Stricture|oesopageal strictures]] have also been reported after thoracic radiotherapy.  

There is little opportunity to use this technique for oesophageal neoplasia as the surrounding organs (the heart and lungs) have a poor tolerance to radiation.  [[Oesophagitis]] and [[Oesophageal Stricture|oesopageal strictures]] have also been reported after thoracic radiotherapy.

==Prognosis==

==Prognosis==