There is more than one question to answer here:
First, radiation for epidermoid cancer of the gus is not always paliative.
It offers about 15% chance of 5 year survival, which is much lower than
that of an operation, but if you consider that only the 'Good' patients
are operated, and that irradiation is given to all cases, the actual 5
year survival data may even be better with irradiation. There are no RCT's
as far as I know. If tumor persists after curative irradiation dose,
surgery can still be contemplated.
Second, the spirometry values you give are good, and with such an
FEV1, there is little additional risk for pulmonary complications.
Third, if I were to operate, I would do a total esophagectomy as you
propose. I don't like bringing the stomach up, because of late
complications due to alkaline reflux. I think that the colon is a better
choice, but if there is doubt about the marginal artery (drummonds) I
would bring the stomach through the esophageal bed.
Lastly, the decision to have an operation or complete the irradiation,
should rest with the patient, not the surgeon or the radiotherapist. You
should present the patient with the data and let her decide.
The PATIENT is trading increased morbidity and immediate mortality risk
for a prospective improved chance of long term survival. It is the
patient who should decide if this is a fair exchange. Some patients would
think it is, while others will thing not.