RESUMO
Between 1972 and 1980, 360 patients were operated upon for the treatment of carcinoma of the esophagus at this university hospital. By adopting a policy of routine endoscopy in all patients with minor esophageal symptoms, early diagnosis was possible. Nutritional and respiratory support preoperatively and postoperatively diminished anastomotic leakages and pulmonary complications. We were able to lower our mortality from 17.6 to 2.6 per cent and to increase our resectablity rate from 60.2 to 85.0 per cent. It is still too early to determine if the Akiyama technique, while permitting an improvement of the results, will increase the five year survival rate.
Assuntos
Neoplasias Esofágicas/cirurgia , Adulto , Idoso , Neoplasias Esofágicas/patologia , Esofagoscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fenômenos Fisiológicos da Nutrição , Cuidados Paliativos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Doenças Respiratórias/etiologia , Doenças Respiratórias/prevenção & controleRESUMO
From 21 March to 22 June 1976, 124 patients with squamous cell carcinoma of the esophagus were randomized for inclusion in a prospective trial of preoperative irradiation. Fifteen patients were excluded because of inoperability. Sixty-seven patients were randomly selected to receive 4,000 rads of cobalt radiation for eight days prior to operation; 57 patients were operated upon without receiving radiation therapy. No significant differences were noted between the two groups with regard to age, sex, tumor site, experience of the surgeon, method of approach or surgical technique. Eight esophageal resections were performed upon 47 of the 62 irradiated patients and 33 of the 47 nonirradiated patients. Of the 62 irradiated patients, 14 died during operation, compared with 11 of the 47 nonirradiated patients, the difference between the two groups not being statistically significant. Irradiation was associated with a higher mortality for lesions in the mid third part of the esophagus, 11 of 29 versus four of 19, but again, the difference was not significant. In the irradiated patients, the five year actuarial postoperative survival rate was 9.5 versus 11.5 per cent for the nonirradiated patients. In conclusion, preoperative radiation therapy does not produce a statistically significant short term or long term benefit in the management of squamous cell carcinoma of the esophagus.
