Carcinoma of the oesophagus in Transkei: treatment by intubation

The management of carcinoma of the oesophagus poses formidable logistic problems in countries such as Transkei where the condition is common and resources are limited. Most patients present late, often with complications, and are reluctant to undergo major surgery. Two hundred and fifty consecutive patients who presented over nine months in Transkei were studied. The incidence increased with age until 70 years and the disease occurred equally in men and women. The neoplasm was predominantly squamous cell (243 patients, 97%) and was found most often in the middle third of the oesophagus (118, 47%). On admission only eight of the 250 patients could take a semi-solid diet and only 21 a fluid diet. The policy where feasible was to introduce a Proctor Livingstone tube endoscopically through the dilated oesophageal stricture by a pulsion technique under light general anaesthesia. When abdominal perforation of the oesophagus seemed likely, retrograde intubation via a gastrotomy was performed. Sixty patients were not intubated, because the stricture was too proximal (47) or could not be dilated adequately (6), the lesion was suitable for resection (6), or the patient refused (1). Fifty one (27%) patients died in hospital, 29 deaths being due to oesophageal perforation (including six of the 10 who were intubated retrogradely). The mean hospital stay was 4.7 days. On discharge 64% of the intubated patients were able to take semi-solid food and a further 6% a fluid diet. Palliation by intubation was performed rapidly and the tube was well tolerated by patients. The overall mortality was high, but this can be reduced by experience. Intubation is an acceptable, cost effective solution where large numbers of patients present with advanced oesophageal carcinoma in circumstances where resources are severely limited.