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CARCINOMA OF THE OESOPHAGUS WITH SURVIVAL
Author(s) -
Dunlop E. E.
Publication year - 1960
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1960.tb03091.x
Subject(s) - medicine , carcinoma , surgery , radiation therapy , general surgery , palliative care , metastasis , cancer , nursing
Summary 1. Some modern trends in the treatment of carcinoma of the oesophagus are discussed. 2. A personal case series of 170 patients with carcinoma of the oesophagus during theperiod 1945 to 1959 and a ten year series from the Royal Melbourne Hospital (1949–1958) are presented. Carcinoma arising in the stomach or gastric cardia are excluded but not those involving both pharynx and oesophagus. Brief reference is made to 32 cases who received radiotherapy at the Peter MacCallum Clinic over the same period 1949 to 1958. 3. The advanced age and frailty of the patients are evidenced, and sex variations discussed in relationship to site. 4. The intractability of many of the lesions is discussed in terms of local metastasis (63 per cent.), blood stream metastasis (15 per cent.) and advanced spread. Reference is made to double carcinoma and vagaries of spread and recurrence. A wide margin of resection is advised if cure be the objective. 5. Views on the place of palliative and radical procedures are advanced in the light of the pathology, the distress of the patients cnd the grim outlook of the untreated disease. 6. Palliatie measures discussed include intubation (with preference for plastic tubes), gadrostomy and jejunostomy (which are not favoured). short circuits, palliative resection and X‐ray therapy. 7. Major surgical excisions were carried out in 68 of the personal case series; lowerthird 33, middle third 44 and upper third 39 with mortality 29 per cent. (15 per cent. lower third, 32.5 per cent. for the upper two‐thirds). 8. On the basis of results obtained in Melbourne there does not appear to be any well‐established case for abandoning surgery for carcinomata of the upper two‐thirds of the oesophagus. 9. A survey of these results together with others available from other countries suggests that the disease is grim indeed, but that surgery offers comfort and some distinct hope of lasting relief.