The surgical management of malignant tumours of the oesophagus and cardia: a review of the results in 292 patients treated over a 15-year period (1961--75).

Of 292 patients, excision of the tumour with replacement by stomach or jejunum was carried out in 216 in whom the lesion was considered operable on both technical and general grounds, intubation was performed in 45 and the remaining 31 were managed without operation. Of the 216 in whom resection was performed, only 20 per cent were free from local spread, lymph node involvement or secondary deposits at the time of operation. Hospital mortality was 18 per cent and did not significantly differ between one 5-year period and another. Survival at 1 year was 54 per cent, at 2 years 25 per cent and at 5 years 14 per cent. The average length of survival following intubation was 2.6 months and following non-operative management 2.8 months. The poor average survival of between 3.5 and 5 months obtained in those patients with secondary deposits at the time of resection suggests that resection is of questionable value in this group. There was a marked difference in survival following Roux loop procedures compared with upper partial gastrectomy for tumours of the lower third and cardia in patients without lymph node involvement or secondary deposits, strongly suggesting that upper partial gastrectomy, although a rather simpler and quicker operation, is not the operation of choice in these patients. On 31 December 1976, after a minimum follow-up of 1 year, there were only 22 patients still alive of the original 292 (7.5 per cent).