[Is the palliative treatment of cancer of the esophagus by retrosternal bypass justified?].

We report a retrospective study of 52 patients with unresectable carcinomas of the esophagus treated with substernal bypass without resection. There were 49 squamous-cell carcinomas and 3 adenocarcinomas. The site of the tumor was the middle third of the esophagus in 32 patients, the upper third in 9, and the lower third in 11. The diagnosis of inextirpability was made preoperatively in 34 patients and at laparotomy in 18. Thoracotomy was never performed. The bypass procedure was ileocolic in 22 cases and gastric in 30 cases. No patient had postoperative chemotherapy or radiation therapy. The operative mortality rate was 9.6 p. 100 (5 cases) and the hospital mortality was 19.2 p. 100 (10 cases). Morbidity was 46 p. 100. Twenty-two cervical fistulas occurred; 19 closed spontaneously. Eighteen endoscopic dilatations and four reoperations were performed for 22 secondary stenoses of the cervical anastomosis. Median survival rate was 6.2 months. We conclude that substernal bypass is a valuable alternative for palliation of esophageal cancer but that its indications should be limited.