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Ann Thorac Surg 1984;38:611-616
© 1984 The Society of Thoracic Surgeons

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Articles

Esophagogastrectomy as Palliative Treatment for Esophageal Carcinoma: Results Obtained in the Setting of a Thoracic Surgery Residency Program

Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC

^* Address reprint requests to Dr. Keagy, 108 Burnett-Womack Bldg 229H, University of North Carolina, Chapel Hill, NC 27514

The palliative treatment of esophageal carcinoma has included intubation, bypass, dilation, irradiation, and esophagogastrectomy. The last has been criticized by some on the basis of high operative morbidity and mortality. To assess the success of this method at our institution, we reviewed the 60 consecutive resections performed for carcinoma of the esophagus from January, 1972, through June, 1983. Forty-six patients had squamous cell tumors and 14, adenocarcinomas. There were 47 men and 13 women, and the mean age was 59.9 years (range, 38.5 to 78.9 years). The most frequent preoperative findings included dysphagia (55), weight loss (34), chest pain (22), and vomiting (49). Fifty (83%) out of the 60 resections were performed by the resident staff under the supervision of an attending surgeon.

Four patients died within 30 days of operation, an operative mortality of 6.7%. Immediate causes of death included respiratory failure, myocardial infarction, hemorrhage, and renal failure. One of the patients who died and 3 of the survivors had an anastomotic leak. There were 27 additional complications in 24 patients: respiratory problems (8), arrhythmias (5), pleural effusion (4), gastric outlet obstruction (2), wound infection (2), and 1 each of pulmonary embolus, acute brain syndrome, congestive heart failure, myocardial infarction, chylothorax, and empyema.

The one-, two-, three-, and five-year actuarial survival rates were 46%, 27%, 10%, and 5%, respectively. Mean survival for the 46 patients dead at the time of this study was 13.5 months. Outpatient follow-up data were available on 53 (95%) of the operative survivors and showed an absence of dysphagia in 87.5% during most of the follow-up period. The data from this study suggest that esophagogastrectomy performed in a well-supervised residency training program can achieve reasonable long-term palliation for carcinoma of the esophagus. The operation can be performed with a low operative mortality and few serious postoperative complications.

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