ESOPHAGOPLASTY WITH ISOPERISTALTIC GASTRIC TUBE IN THE PALLIATIVE TREATMENT OF ESOPHAGUS CARCINOMA
Keywords:
esophagus, carcinoma, neoplasms, palliative care, esophagoplastyAbstract
OBJECTIVE
To evaluate the benefit of palliative treatment by esophageal diversion with an isperistaltic gastric tube in patients with unresectable esophageal carcinoma.
Methods
20 patients with squamous cell carcinoma of the esophagus, without resectability conditions, were studied, evaluated by clinical, endoscopic and radiological criteria. Sixteen patients were male, with a mean age of 57 years. The operation performed was esophageal diversion with the isoperistaltic gastric tube, which was prepared using the greater curvature, transposed through the retrosternal space and anastomosed in the cervical esophagus.
Results
Ten patients (50%) developed one or more complications, the most frequent of which was dehiscence and/or stenosis of the cervical anastomosis (six patients - 30%). Of the 17 patients who survived, 14 (82.3%) reported relief of dysphagia during postoperative follow-up. The average survival rate in eight patients was six and a half months (five to nine months) and nine patients are being followed up for a period varying between one and nine months, with good evolution.
Conclusion
Isoperistaltic gastric tube has acceptable morbidity and mortality for the study population, allowing palliation of dysphagia in most cases.
Downloads
References
Abe S, Tachibana M, Shimokawa T, Shiraishi M, Nakamura T. Surgical treatment of advanced carcinoma of the esophagus. Surg Gynecol Obstet 1989; 168:115-20.
Alcântara PSM, Spencer-Netto FAC, Silva-Junior JF, Soares LA, Pollara WM, Bevilacqua RG. Gastro-esophageal isoperistaltic bypass in the palliation of irresectable thoracic esophageal cancer. Int Surg 1997; 82:249-53.
Beck C, Carrell A. Demonstration of specimens illustrating a method of formation of a prethoracic esophagus. Illinois Med J 1905; 7:463-68.
Fan ST, Lau WY, Yip WC, Poon GP, Yeung C, Lam WK, et al. Prediction of postoperative pulmonary complications in esophago-gastric cancer surgery. BrJ surg 1987; 74:408-10.
Lorentz T, Fok M, Wong J. Anastomotic leakage after resection and bypass for esophageal cancer: lessons leraned from thepast. World J Surg 1989; 13:472-77.
Mannel A, Becker PJ, Nissenbaum M. Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases. BrJ surg 1988; 75: 283-86.
Meniconi MTM. Estudo prospectivo da aplicação do tubo gástrico de grande curvatura, isoperistaltico, no tratamento da neoplasia avançada de esôfago. Análise de 50 casos [thesis]. São Paulo: Faculdade de Medicina Universidade de São Paulo; 1997.
Mirra AP, Guida Filho B, Miziara JEA, Trippe N, Mourão Neto M, Neri FE, et al. Tratamento do câncer do esôfago torácico e abdominal: casuística de 103 casos operados. Rev Paul Med 1976; 88: 118-27.
Moreira LS, Coelho RCL, Sada1aRU, Dani R. The use of ethanol injection under endoscopic control to palliate dysphagia caused by esophagogastric cancer. Endoscopy 1994; 26: 311-14.
Moura EGH. Tratamento paliativo do cancer do esôfago por endopr6tese e tubo gástrico isoperistaltico [thesis]. Faculdade de Medicina Universidade de São Paulo; 2000.
O'Hanlon DM, Harkin M, Karat D, Sergeant T, Hayes N, Griffin SM. Quality of life assessment in patients undergoing treatment for oesophageal carcinoma. Br J surg 1995; 82: 1682-85.
Orel JJ, Vidmar SS, Hrabar BA. Intrathoracic gastric and jejunal bypass for palliation of nonresectable esophageal carcinoma. Int Surg 1982; 7:147-51.
Orringer MB, Marshall B, Stirling MC. Transhiatal esophagectomy for benign and malignant disease. Thoracic Cardiovasc Surg 1993; 105:265-76.
Orringer MB. Subesternal gastric bypass of excluded esophagus: results of na ill-advised operation. Surgery 1984; 96:467-70.
Paricio PP, Garcia-Marcilla JA, Martinez-de-Haro L, Ortiz-Escandell MA, Catallanos-Escrig G. Results of surgical treatment of epidermoid carcinoma of the thorcic esophagus. Surg Gynecol Obstet 1993; 177: 398-404.
Pinotti HW, Felix VN, Raia AA. Revisão e análise crítica das técnicas de restabelecimento do trânsito esofágico. An Paul Med Cir 1978; 105:1-28.
Postlethwait RW. Technique for isoperistaltic gastric tube for esophageal bypass. Ann Surg 1979; 189: 673-76.
Reed CE. Comparison for different treatments for unresectable esophageal cancer. World J Surg 1995; 19:828-35.
Saito T, Shigemitsu Y, Kinoshita T, Yoshioka M, Isechi S. Extended survival time for esophageal cancer patients treated with aggressive surgery and concurrent chemoradiation. Int Surg 1994; 79: 93-7.
Siegel HI, Laskin KJ, MA, Fisher RS, Krevsky B. The effect of endoscopic laser therapy on survival in patients with squamouscell carcinoma of the esophagus. Further Experience. J Clin Gastroenterol 1991; 13: 142-46.
Speranzini MB, Fujimura I, Pires PWA, Mittelstaedt WEM, Deutsch CR, Bourroul Filho RC, et al. Esofagoplastia com tubo gåstrico isoperiståltico em derivagäo no tratamento do cåncer do esöfago toråcico: estudo de 13 casos. Rev Assoc Med Brasil 1989; 35:91-8.
Watanabe H. The techniques to protect the anastomotic leakage of esophagosgastrostomy at the neck. Nippon Geka Gakkai Zasshi, 1996; 97:432-36 [resumo].
Zhang DW, Cheng GY, Huang GJ, Zhang RG, Liu XY, Mao YS, et al. Operable squamous esophageal cancer: current results from the east. World J Surg 1994; 18: 347-57.
Zilberstein B, Cecconello I, Pollara WM, Pinotti HW. Emprego do jejuno no restabelecimento do trânsito-esofágico, análise crítica das técnicas e dos resultados. In: Pinotti HW. Condutas técnicas na cirurgia do esôfago. [s.l.]: Kronos; 1982. p.80.
Zilberstein B, Pinotti HW, Cecconello I, Ibraim RE. Câncer do esôfago. In: Pinotti HW, editor. Tratado de clínica cirúrgica do aparelho digestivo. São Paulo: Atheneu; 1994. p.415-26.
Zilberstein B. Esofagectomia cervico-abdominal por via transdiafragmática no tratamento cirúrgico do câncer do esófago. Resultados e evolução a longo prazo [thesis]. São Paulo: Faculdade de Medicina Universidade de São Paulo; 1988.
