THE ROLE OF SURGERY AND LASER-ABLATION IN ESOPHAGEAL-CARCINOMA

Between January 1990 and December 1994 oesophagectomy was carried out in 42 patients and comparison made with 38 who had palliative laser th erapy, Apart from six patients referred after being unresectable at su rgical exploration there were no agreed selection criteria, although t he laser patients were in general older (mean 64 V 73 year) with a hig her proportion of cardiorespiratory co-morbidity (14 per cent V 18 per cent). Lateral margins were involved in 14 per cent of known palliati ve resections with 50 per cent having positive nodes. The mean operati ng time was three hours and two chest drains inserted electively were removed after 3.6 days with mean drainage of 817 mi, The mean ICU stay was 5.4 days and 3 had radiological leaks; all but one settled conser vatively. The 90 day mortality was 11.9 per cent for surgery and 34 pe r cent for laser patients, Twenty-three patients (61 per cent) require d further courses of laser-therapy for benign anastomotic stenosis, In cluding the initial treatments of both groups 6.0 procedures per patie nt year were required in the laser groups compared with 1.1 for surger y. The 1, 2 and 3 year survival was 60 per cent, 31 per cent, 39 per c ent for surgery compared with 24 per cent, 8 per cent, 3 per cent for laser - 12 surgical patients are still alive and well at mean of 29 mo nths (range 16-68), Surgery where possible with acceptable morbidity a nd mortality offers good palliation and long-term survival is possible ; selection criteria for palliation only need to be defined.