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Ann Thorac Surg 1992;53:1010-1014
© 1992 The Society of Thoracic Surgeons

Articles

Push-through intubation: Effective palliation in 409 patients with cancer of the esophagus and cardia

Antonino Cusumano, MD, Alberto Ruol, MD*, Andrea Segalin, MD, Lorenzo Norberto, MD, Marco Baessato, MD, Ermanno Tiso, MD, Alberto Peracchia, MD

First Department of Surgery, University of Padua, Padua, Italy

Accepted for publication October 25, 1991.

* Address reprint requests to Dr Ruol, First Department of Surgery, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.

Between 1980 and 1989, 355 patients with cancer of the esophagus and 54 with cancer of the cardia underwent push-through intubation because of advanced tumor stage oc medical contraindications to tumor resection. In 36 other parents (8.1%), the attempt at transtumoral intubation failed. The hospital mortality rate after intubation was 3.4%. The following complications were observed: hemorrhage in 2.0% of the patients, esophageal perforation in 4.9%, tube dislodgment in 12.7%, and tube obstruction in 4.4%. Early resumption of semisolid oral feeding was possible in 80% of the discharged patients. The actuarial 1-year survival rate was 7.7% and the median survival, 3.9 months. In conclusion, pushthrough intubation represents a valid therapeutic choice, which is indicated mainly for patients with a long, infiltrating, and circumferential stricture of the thoracic esophagus or cardia that is inoperable and for patients with an esophagorespiratory or esophagomediastinal fistula.




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