Particular aspects and limits of palliation of secondary malignant esophageal strictures

The value of palliative intubation in the secondary malignant stricture of the thoracic esophagus is discussed. One hundred and eleven patients with secondary involvement of the esophagus due to primary inoperable (in 64) or recurrent bronchial tumor (after lobectomy or pneumonectomy in 34) and mediastinal tumor (in 9) or metastases after mastectomy of breast cancer (in 4) underwent a limited invasive surgical intubation with a personally designed, composite tube in the past 15 years. The distal part of the tube is detachable, which allows insertion of the tube only into the esophagus. The overall hospital mortality was 9.9%. Esophageal perforation and intraabdominal septic complication were never recorded. Nonfatal complication rate was low (5.4%). All survivors have resumed on oral soft diet. By this technique, all attempts of tube insertion were successful, although in 33% of the cases various esophageal axis deviations or tortuosity were present. Reintubation for tube dislodgement was necessary in 7.2% of the patients. Stenotic tracheobronchial invasion, vena cava superior syndrome, bronchial stump fistula as well as cardiac arrhythmias are the main contraindications of the palliative intubation in such cases. In the remaining group of patients with secondary invasion of the esophagus by intrathoracic malignancies, intubation may be considered a unique type of management with acceptable risk.