Intrathoracic gastric and jejunal bypass for palliation of nonresectable esophageal carcinoma.

From 1963 to 1980, intrathoracic bypass anastomosis was performed in 42 patients with nonresectable esophageal carcinoma. In this study 25 patients are reported on; of these, seven presented with midthoracic and one with lower thoracic esophageal tumor, 13 with carcinoma of the cardia and four with recurrences on the esophagogastric anastomosis. Seven underwent left, and eight right intrathoracic esophagogastrostomy, whereas ten underwent left intrathoracic esophagojejunostomy. Exclusion of the esophagus was not performed in any of these cases. Dehiscence occurred in three (12%) anastomoses. Nine patients (36%) died in the early postoperative period. The majority of surviving patients (12/18) were able to consume solid food. The mean survival period was 6.3 months (min. 1 mo, max. 14 mos). Most patients died of cachexia. A bypass anastomosis is the best palliative procedure in nonresectable esophageal carcinoma. A relatively high mortality, however, necessitates a strict selection of patients.