MANAGEMENT OF UNRESECTABLE ESOPHAGEAL CANCER - A REVIEW OF 537 PATIENTS

We compared and contrasted the potentials of palliation afforded by va rious management methods in a retrospective study of all patients refe rred to one surgical team in a 20-year period. Five hundred thirty-sev en patients had unresectable oesophageal cancer. There were five treat ment groups: group 1 - dilatation plus external radiotherapy (DXR, n = 95), group 2 - gastrostomy plus DXR (n = 18), group 3 - permanent int ubation (n = 329), group 4 - oesophageal bypass (BP, n = 70), and grou p 5 - YAG laser plus brachytherapy (n = 25). Groups 1 and 2 had high m ortality (4% and 25 %) and poor symptom relief, with an average surviv al of 2.5 and 3.5 months, respectively. Group 3 had a 20 % mortality r ate, moderate-to-good symptom relief and an average survival of 4.2 mo nths. This method was best for lower oesophageal cancer. Group 4 had a 22% mortality rate, good symptom relief and an average survival of 10 .5 months. The BP method was suitable for patients with oesophago-airw ay fistula (OAF) and those with lower oesophageal cancer found unresec table at operation. Group 5 had a hospital mortality rate of 8%, good symptom control and an average survival of 6.2 months. This was suitab le for all patients (except those with OAF). In palliation of carcinom a of the oesophagus the selection of method should be made to suit the characteristic and location of the tumour.