A study of the quality and duration of survival following resection, endoscopic intubation and surgical intubation in oesophageal carcinoma.

A series of 130 cases of oesophageal carcinoma managed by one surgeon in a unit with a major interest in oesophageal disorders is reviewed. The management policy has been an active one of resection in suitably selected cases, less favourable ones being treated by operative intubation before 1979 and by endoscopic intubation since 1979. Operative mortality and morbidity have been compared between the three groups, together with duration of survival and quality of swallowing as measured by a modified Visick grading. In the intubated groups, endoscopic intubation carried a hospital mortality of 15.6 per cent compared with 40.8 per cent in the operative group. It was associated with less morbidity and a better quality of survival, although survival times were comparable and did not exceed 18 months in either group. In the resection group, hospital mortality was 12.2 per cent, and both the mean survival and quality of swallowing were greater than in either endoscopic group. It is concluded that in suitably selected cases, resection can be performed with a mortality considered acceptable for palliative intubation whilst conferring greater survival and restoration of normal swallowing. In less favourable cases, endoscopic intubation is superior to operative intubation in terms of reduced mortality and better restoration of swallowing.