GASTRIC BYPASS FOR MALIGNANT ESOPHAGOTRACHEAL FISTULA - A SERIES OF 21 CASES

Objective: Patients with cancer of the esophagus who develop an esopha gotracheal fistula die within 1 month in dramatic conditions of malnut rition and asphyxia. We assessed the beneficial palliative effect of t he Kirschner operation in the treatment of esophagotracheal fistula. M ethods: Between January 1980 and August 1995, 21 patients among a cont inuous series of 847 with cancer of the esophagus developed an esophag otracheal fistula. Prior to surgery, 2 patients had an esophageal pros thesis followed by radio- and/or radiochemotherapy and 6 had radio-and /or chemotherapy at curative doses. The Kirschner operation was carrie d out in all patients with exclusion of the lower end of the esophagus using a Roux-en Y-loop (n = 19) or ligature (n = 2). Results: Within 1 month of surgery, 8 patients (38%) died. Median length of stay in th e intensive care unit and hospitalization was 6 days (1-30) and 17 day s (3-57), respectively. Among the 13 survivors, pulmonary infections ( n = 2) and cervical fistulae (n = 5) complicated the postoperative per iod. Among the cervical fistula, 3 of them resolved favorably. Radio- and/or chemotherapy was given postoperatively in 7 patients without an y improvement in survival. Among the 13 patients surviving beyond the postoperative period, median survival was 109 days; 7 were able to res ume oral nutrition and quality of life was assessed as excellent in 6 of them. Conclusion: The Kirschner operation can provide a beneficial palliative effect in patients with an esophagotracheal fistula despite the high risk of operative mortality. Ideally, the Kirschner should b e carried out in young patients who are still in good general health, before the development of respiratory complications compromises surger y. (C) 1998 Elsevier Science B.V. All rights reserved.