Management of unresectable oesophageal cancer: A review of 537 patients

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Abstract
We compared and contrasted the potentials of palliation afforded byvarious management methods in a retrospective study of all patientsreferred to one surgical team in a 20-year period. Five hundred thirty-seven patients had unresectable oesophageal cancer. There were fivetreatment groups: group 1-dilatation plus external radiotherapy (DXR, n =95), group 2-gastrostomy plus DXR (n = 18), group 3-permanent intubation (n= 329), group 4-oesophageal bypass (BP, n = 70), and group 5-YAG laser plusbrachytherapy (n = 25). Groups 1 and 2 had high mortality (4% and 25%) andpoor symptom relief, with an average survival of 2.5 and 3.5 months,respectively. Group 3 had a 20% mortality rate, moderate-to-good symptomrelief and an average survival of 4.2 months. This method was best forlower oesophageal cancer. Group 4 had a 22% mortality rate, good symptomrelief and an average survival of 10.5 months. The BP method was suitablefor patients with oesophago- airway fistula (OAF) and those with loweroesophageal cancer found unresectable at operation. Group 5 had a hospitalmortality rate of 8%, good symptom control and an average survival of 6.2months. This was suitable for all patients (except those with OAF). Inpalliation of carcinoma of the oesophagus the selection of method should bemade to suit the characteristic and location of the tumour.

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