Surgical treatment of advanced carcinoma of the esophagus.

This report was done to evaluate the role of surgical treatment of locally advanced carcinoma of the esophagus. All 32 patients had histologically proved epidermoid carcinomas of the esophagus. The post-operative one and two year survival rates and median survival time were 34.6 and 17.3 per cent and 199 days for those in the group undergoing esophagectomy, zero per cent and 55 days for those in the group with bypass and zero per cent and 80 days for those undergoing formation of a stoma. Thirty day postoperative mortality rates were zero per cent for the esophagectomy group, 25.0 per cent for the stoma group and 33.3 per cent for the bypass group. When calculated from the date of diagnosis, the one and two year survival rates and the median survival time were 50.2 and 16.7 per cent and 296 days for the esophagectomy group, 16.7 and zero per cent and 196 days for the bypass group, 25.0 and zero per cent and 142 days for the stoma group and zero per cent and 142 days for the group who did not undergo surgical treatment. Complication related postoperative deaths occurred in 14.8 per cent of the 27 patients operated upon. For those in the esophagectomy group, it was 5.9 per cent, and for the bypass group, 50.0 per cent. Swallowing was improved in 58.8 per cent after esophagectomy, but in none of the patients was swallowing restored after the bypass procedures. When the invasion spared the aorta or major respiratory tract, postoperative survival time after esophagectomy was significantly better. Considering the short postoperative survival time and frequent complications, bypass procedure should not be the final resort after nonsurgical treatment.