Treatment of esophageal carcinoma: a retrospective review

Two hundred fourteen patients underwent treatment for carcinoma of the esophagus between January, 1950, and July, 1978, with an over-all 5 year survival rate of 1.9%. Forty-six patients (21.5% of series) underwent esophageal resection with either esophagogastrostomy (37 patients) or colon interposition (nine patients). The operative mortality rate was 18.9% for the esophagogastrectomy group and 33% for the colon interposition patients. "Curative" resections resulted in a 14.3% 5 year survival rate. One hundred twenty-seven patients (59.3% of series) were treated by irradiation therapy, with a mean survival time of 9.6 months for patients receiving "curative" dosage (over 4,500 rads). There were no 5 year survivors in this group. Palliative procedures, such as feeding gastrostomy and palliative (less than 4,500 rads) irradiation therapy, contributed little to patient comfort or survival. We favor a palliative approach to the treatment of esophageal carcinoma and believe that, when possible, esophageal resection with esophagogastrostomy is the preferable form of therapy and offers an occasional cure.