Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases.

The early and late results of bypass surgery in 124 patients with unresectable oesophageal cancer are reported. Patients were grouped according to the extent of disease: group A, tumour localized to the oesophagus where severe pulmonary disease contra-indicated oesophagectomy (n = 9); group B, tumour less than or equal to 10 cm in length with mediastinal invasion (n = 81); group C, tumour greater than 10 cm in length with mediastinal invasion and/or fixed malignant lymph nodes (n = 33). Extent of disease was not recorded in one patient. The operative mortality was 4 per cent but 9 other patients died in hospital (hospital mortality, 11 per cent). Mortality was increased in patients undergoing colon bypass and in those with a large tumour load but these differences failed to reach statistical significance. The most frequent complication was neck sepsis, secondary to leakage from the proximal end of the excluded oesophagus. Eighty-nine per cent of the survivors could eat a normal, unrestricted diet on discharge and eighty-two per cent of survivors had complete and lasting relief from dysphagia. Median survival after bypass was 5 months but survival was significantly improved by radiotherapy to the tumour (P less than 0.001). Gastric bypass with radiotherapy is indicated in patients with extra-oesophageal spread of malignancy and in patients with tumours localized to the oesophagus who are unfit for resection. Bypass surgery may be contra-indicated in patients with a primary tumour greater than 10 cm in length and/or fixed lymph node metastases because mortality is increased and survival after operation is short.