Esophagogastrectomy. Successful palliation for esophageal carcinoma

Although esophagogastrectomy offers the best chance for cure and alleviation of dysphagia in the treatment of esophageal carcinoma, the operative mortality and morbidity can be prohibitively high. To investigate means for reducing the rate of surgical complication, a study was made of a six-year series of 36 procedures involving 32 esophagogastrostomies and four colon interpositions. Patient survival rates were 60 percent at one year, 40 percent at two years, and 9 percent at five years with a mean survival of 22 months. Histology of the tumor did not significantly affect prognosis. The three operative mortalities were caused by pulmonary insufficiency in one overhydrated patient, and coagulopathy in two alcoholic patients with underlying liver disease. Anastomotic leakage, the precipitating factor for the majority of operative mortalities in the recent literature, occurred in one non-fatal case. This low incidence is linked to the implementation of steps to maximize blood supply and minimize tension on the anastomosis line. Anastomotic stricture was seen and easily dilated in three patients. The five cases of intra-esophageal tumor recurrence which occurred despite tumor-free margins may have been avoided by more extensive resection.