The goal of the treatment in patients with advanced esophageal carcinoma is to alleviate dysphagia. BACKGROUND: The objective of this study is to report the authors' experience with gastric esophageal bypass using isoperistaltic gastric tube followed by radiotherapy, in the treatment of patients with unresectable esophageal carcinoma. METHOD: From 1990 to 1999, 30 patients underwent bypass surgery. Twenty four patients (80%) were male and six (20%) female, age ranged from 27 to 69 years, with a mean age of 49.3 years. Diagnosis was confirmed by esophagogastroduodenoscopy and biopsy in all patients. Those with tumors greater than 6 cm at esophagography or with signs of invasion of the respiratory sistem at bronchoscopy were considered unresectable. Bypass surgery was carried out after medical assessment and preoperative evaluation. Surgery was performed by two teams, one at the cervical area and another at the abdominal area. Surgical time ranged from 3 to 4 hours. After hospital discharge, patients were referred to radiotherapy. RESULTS: There was no operative mortality. Postoperative mortality was 10%, one case of pulmonary thromboembolism and two cases of pneumonia. Thirteen patients (43.3%) developed cervical anastomotic leak and eleven had spontaneous resolution; one required a new operation and another patient died at postoperative day 14, with an open fistula. Eight patients (26.6%) had anastomotic stenosis, and all of them had a good outcome with endoscopic dilation. Deglutition was reestablished in all patients until death, excluding those who died as a result of postoperative complications (3 cases). Hospitalization time ranged from 12 to 45 days and mean survival rate was 7.9 months. CONCLUSIONS: We concluded that, in patients with esophageal unresectable carcinoma, obstruction bypass using an isoperistaltic gastric tube alleviates dysphagia symptoms until death. Morbidity is high, even though most of the complications have a benign outcome. The mortality rate is acceptable taking into consideration the severity of esophageal carcinoma.
Esophageal carcinoma; Isoperistaltic gastric tube; Correction surgery
