RETROSTERNAL BYPASS OPERATION FOR UNRESECTABLE SQUAMOUS-CELL CANCER OF THE ESOPHAGUS

Background. A palliative bypass operation may be beneficial when sever e dysphagia or tracheoesophageal fistula occurs after radiochemotherap y for unresectable tumor of the esophagus. Methods. Thirty-two patient s with an unresectable tumor of the esophagus underwent a palliative r etrosternal gastric (29) or colonic (3) bypass operation with ligature of the Lower esophagus (3) or drainage (27). Tracheoesophageal fistul a was present at operation in 20 (62.5%), including 8 after radiochemo therapy. Results. The overall operative mortality rate was 34.4%: 45% with tracheoesophageal fistula and 16.6% without (p < 0.01). Median in tensive care and hospitalization times were 5 and 19 days, respectivel y. Median postoperative survival was 6 months (range, 53 to 499 days). Complications in 21 survivors were lung infections (seven), cervical fistulas (eight), and failure of the esophageal suture (two); 19 patie nts resumed oral nutrition, and quality of life was excellent in 6. Al l eight cervical fistulas regressed favorably. postoperative radiother apy or chemotherapy did not improve survival. Conclusions. Despite the high operative mortality rate, bypass operation can provide good pall iation and allow subsequent radiochemotherapy in selected patients wit h an unresectable tumor of the esophagus.