The Annals of Thoracic Surgery, Vol 33, 464-472, Copyright © 1982 by The Society of Thoracic Surgeons
Carcinoma of the esophagus: twelve years' experience with a philosophy for palliation
JR Hankins, FN Cole, S Attar and JS McLaughlin
Twelve years of experience have now been gained with a new therapeutic
approach to carcinoma of the esophagus. In this approach, the primary goal
of treatment is palliation, with cure an important but secondary objective.
Carcinomas in the upper third of the esophagus are treated by radiation
therapy unless there is severe obstruction or tracheal invasion, in which
case colon interposition is performed. Limited resection with
esophagogastrostomy is performed through a right thoracotomy and midline
laparotomy for neoplasms in the middle third of the esophagus and through a
left thoracotomy for carcinomas in the lower third. Since 1969, 161
patients have been evaluated, of whom 107 (66%) have been managed according
to the new protocol. Twenty patients with carcinomas of the upper third of
the esophagus were treated primarily by radiotherapy and 7 by colon
interposition. Resection was performed in 78 of the 80 patients with
carcinomas of the middle and lower thirds. There were 9 operative deaths
(10%). Palliation, of superior quality to that obtained by previous
methods, was provided to 95 of the 107 patients. Survival also is at least
on a par with that obtained before.
