Esophageal carcinoma. A six-year review of the cleveland veterans administration hospital experience

The records of 51 patients with esophageal carcinoma were reviewed. Twenty-two patients underwent attempted curative resection with a mean survival of 7.7 months. Twenty patients underwent primary radiotherapy (mean survival, 4.3 months). Nine patients received palliative therapy alone (mean survival, 2.8 months). Surgical mortality was 27%, but symptomatic palliation was complete in 59% of the surgical patients. Only 5% of the radiotherapy group, and 11% of the palliative group were completely palliated. There is only one long-term survivor (21 + months). Lesions in the middle third of the esophagus, and the presence of clinical evidence of metastatic disease were predictive of a shorter survival. Patients with metastatic disease at presentation had a mean survival of only 2.5 months from diagnosis. It is concluded that surgery should be considered a palliative, not curative procedure, and that it should be attempted only in those patients without clinical evidence of metastatic disease.