The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 44-49, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Carcinoma of the esophagus. An aggressive one-stage palliative approach
TH Hoffmann, JR Kelley, FL Grover and JK Trinkle
We reviewed the records of 44 consecutive patients with advanced esophageal
carcinoma treated at either a Veterans Administration or a city-country
hospital. The patients, 38 men and six women, ranged in age from 27 to 72
years and had been referred for operative management. The average duration
of dysphagia was 5 months. All patients underwent a one-stage
esophagogastrectomy with esophagogastrostomy. The last 34 patients also had
a modified fundoplication. Lesions at the gastroesophageal junction were
approached via a low left thoracotomy and the others via a simultaneous
right thoracotomy and laparotomy. All patients had preoperative enteral or
parenteral hyperalimentation. Seven patients died within 30 days after
operation (operative mortality 16%). Twenty-six patients lived from 3 to 28
months postoperatively (average 11.5 months). Eleven are alive at present
(average 10 months). Postoperative complications were as follows:
anastomotic leak, three patients (two died); respiratory failure, four (two
died); stricture, three; myocardial infarction, two (two died);
cholecystitis, one; and pulmonary embolus, one (patient died). Thirty-four
patients had modified fundoplication, and an inconsequential anastomotic
leak developed in one. In contrast, two of the 10 patients who did not have
modified fundoplication died as a result of anastomotic leak. Preoperative
hospital stay ranged from 10 to 28 days (average 18); postoperative stay
ranged from 10 to 40 days (average 16). Except for the three patients in
whom stricture developed, all patients (92%) had continuous relief of
dysphagia. We conclude that one-stage esophagogastrectomy with
esophagogastrostomy is applicable in most cases and is associated with both
satisfactory long-term palliation and a reasonable period of
hospitalization. The addition of a modified fundoplication results in a
relatively low rate of anastomotic leak.
