The Annals of Thoracic Surgery, Vol 23, 400-408, Copyright © 1977 by The Society of Thoracic Surgeons
Carcinoma of the esophagus: experience with a philosophy for palliation
JR Hankins, FN Cole, S Attar and JS McLaughlin
The preliminary results of a new therapeutic approach to carcinoma of the
esophagus were reported in 1972. The primary objective of treatment should
be palliation, with cure an important but secondary goal. Lesions in the
upper third of the esophagus are treated by irradiation unless there is
severe obstruction or tracheal involvement, in which case colon bypass is
carried out. Limited resection and esophagogastrostomy is performed through
a right thoractomy and midline laparotomy for middle-third lesions and
through a left thoracotomy for lower-third carcinomas. Since 1969, 85
patients have been evaluated, of whom 65 (76%) have been treated according
to the new protocol. Thirteen patients with upper-third carcinomas were
treated primarily by radiation therapy and 6 by colon bypass. Resection was
performed in 45 of the 46 patients with middle- and lower-third lesions.
There were 5 operative deaths (9.8%). The quality and duration of
palliation have been far superior to that achieved by previous methods of
treatment and, perhaps surprisingly, survival rates have improved.
