Substernal gastric bypass of the excluded esophagus--results of an ill-advised operation

Substernal gastric bypass of the excluded thoracic esophagus for palliation of esophageal carcinoma was proposed as a method of providing maximum patient comfort with minimum morbidity. Our results with this operation in 37 patients are reviewed and indicate that the procedure carries unacceptable complication and mortality rates. Among our patients, there have been nine (24%) hospital deaths, seven (19%) anastomotic leaks, and six (17%) disruptions of the divided distal thoracic esophagus. Major postoperative complications have occurred in 59% of these patients. Only 15 (54%) of the 28 survivors were discharged swallowing within 3 weeks of operation, and 10 (36%) required hospitalization for 1 month or longer after operation. The average survival time in those leaving the hospital alive has been only 5.9 months. Only seven patients (25% of the survivors) have achieved good palliation with the bypass procedure. It is concluded that substernal gastric bypass of the excluded thoracic esophagus is too much of an operation for patients with unresectable tumors who have a life expectancy of only several months.