Management of unresectable oesophageal cancer: a review of 537 patients.

We compared and contrasted the potentials of palliation afforded by various management methods in a retrospective study of all patients referred to one surgical team in a 20-year period. Five hundred thirty-seven patients had unresectable oesophageal cancer. There were five treatment groups: group 1-dilatation plus external radiotherapy (DXR, n = 95), group 2-gastrostomy plus DXR (n = 18), group 3-permanent intubation (n = 329), group 4-oesophageal bypass (BP, n = 70), and group 5-YAG laser plus brachytherapy (n = 25). Groups 1 and 2 had high mortality (4% and 25%) and poor symptom relief, with an average survival of 2.5 and 3.5 months, respectively. Group 3 had a 20% mortality rate, moderate-to-good symptom relief and an average survival of 4.2 months. This method was best for lower oesophageal cancer. Group 4 had a 22% mortality rate, good symptom relief and an average survival of 10.5 months. The BP method was suitable for patients with oesophago-airway fistula (OAF) and those with lower oesophageal cancer found unresectable at operation. Group 5 had a hospital mortality rate of 8%, good symptom control and an average survival of 6.2 months. This was suitable for all patients (except those with OAF). In palliation of carcinoma of the oesophagus the selection of method should be made to suit the characteristic and location of the tumour.