Palliation of esophageal cancer--operative resection versus laser and afterloading therapy

Since 1985, 71 patients with end-stage esophageal cancer have been treated either by surgical (n = 26) or endoscopic laser palliation (n = 45). In 16 of 45 patients treated by endoscopy, additional radiotherapy (extrenal and endoluminal irradiation) was performed. Surgery and Nd:YAG recanalization were initially effective in removing the malignant obstruction in 80% of cases. There were no significant differences in survival in either group. The stenosis-free interval was longer in patients who underwent surgery: 24 weeks; minimal stenosis-free interval: 20 weeks. Local recurrences occurred earlier in the endoscopic study group (mean survival: 36 weeks; minimal stenosis-free interval: 20 weeks). Most stenoses successfully underwent further laser treatment. Although only 35% of patients treated endoscopically underwent additional afterloading therapy, this treatment appears to prolong palliation (mean survival: 38 weeks; minimal stenosis-free interval: 36 weeks). A few patients bled after endoscopy and were treated conservatively. The most important complication in the afterloading group was esophagobronchial perforation, which caused one death in our series. Transient pulmonary problems were the most common complication (31%) in the surgical group with a hospital mortality of 19%. Overall, the improvement in the quality of life after surgery was better. However, our results show that Nd:YAG recanalization and afterloading therapy are effective therapeutic alternatives in patients unfit for surgery.