[Intraluminal irradiation with iridium 192--a new method for the treatment of inoperable esophageal cancers?]

Palliative and curative surgical therapy of malignant stenoses of the esophagus and cardia

Between January 1967 and July 1986, 171 patients with malignant stenosis of the esophagus and cardia were subjected to curative or palliative surgical treatment. Specifically, there were 84 primary esophageal carcinomas, 5 cases of malignant esophageal stenosis caused by an extra-esophageal malignant tumor (inter alia bronchial carcinoma), and 82 primary carcinomas of the cardia. The average age of the patients as a whole was 63.7 years, and the sex ratio (male:female) was 4.0:1. In 18 esophageal carcinoma patients and 21 patients with carcinoma of the cardia curative resection was possible, but in 132 patients merely palliative surgery was performed, most frequently esophageal intubation and gastrostomy. The specific operations with a curative objective performed upon the esophageal carcinoma patients were abdominothoracic esophageal resection with upward displacement of the stomach (n = 16) or interposition of a colonic segment (n = 2), whereas in the patients with carcinoma of the cardia, proximal resection was performed in 13 cases, either subtotally or as a cardiofundectomy, and total gastrectomy in 8 cases. For the subsequent reconstruction of the passage the interposition of a jejunal segment was most frequently used. The clinical mortality for the curative resections was 33% for the 18 esophageal carcinoma patients and 9.5% for the 20 patients with carcinoma of the cardia. The long-term survival rates are depressing: of the patients who underwent curative resection 47.6% were still alive after one year, 28.6% after 2 years and 14.3% after 5 years. Of the patients treated only palliatively on account of an already advanced stage of the tumor, 91.5% died within the first year; only 4.9% of patients from this group were still alive after 2 years.