Esophageal cancer: Results of therapy in an indigent population

The Tumor Clinic charts of 118 patients with esophageal carcinoma were reviewed. Of these patients 101 had squamous cell carcinoma. All were from an indigent patient population, and had a high rate of alcoholism, heavy smoking, and malnutrition. Most of the patients presented with dysphagia or pain. However, on review, significant weight loss antedated these symptoms by many months. Earlier diagnosis might be achieved in many instances by a careful esophageal workup in those patients with unexplained weight loss. The duration of dysphagia does not correlate with length of survival after therapy. The data indicates that esophagectomy offers the best chance for cure, and longer significant palliation. The significant morbidity and mortality of this procedure in the malnourished patient can be minimized only by careful attention to operative technique. An experienced senior surgeon should attend this procedure when it is performed by resident surgeons in a teaching situation. Radiotherapy should be reserved for use as an adjuvant to surgery preoperatively, or for patients whose associated disease precludes surgical resection.