title: Retrosternal bypass operation for unresectable squamous cell cancer of the esophagus.
abstract: BACKGROUND
  A palliative bypass operation may be beneficial when severe dysphagia or tracheoesophageal fistula occurs after radiochemotherapy for unresectable tumor of the esophagus.
  
  
  METHODS
  Thirty-two patients with an unresectable tumor of the esophagus underwent a palliative retrosternal gastric (29) or colonic (3) bypass operation with ligature of the lower esophagus (3) or drainage (27). Tracheoesophageal fistula was present at operation in 20 (62.5%), including 8 after radiochemotherapy.
  
  
  RESULTS
  The overall operative mortality rate was 34.4%: 45% with tracheoesophageal fistula and 16.6% without (p < 0.01). Median intensive care and hospitalization times were 5 and 19 days, respectively. Median postoperative survival was 6 months (range, 53 to 492 days). Complications in 21 survivors were lung infections (seven), cervical fistulas (eight), and failure of the esophageal suture (two); 19 patients resumed oral nutrition, and quality of life was excellent in 6. All eight cervical fistulas regressed favorably. Postoperative radiotherapy or chemotherapy did not improve survival.
  
  
  CONCLUSIONS
  Despite the high operative mortality rate, bypass operation can provide good palliation and allow subsequent radiochemotherapy in selected patients with an unresectable tumor of the esophagus.
authors.affiliation: Department of Digestive Surgery, Centre Hospitalier, Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Meunier
authors.forename: Y
authors.initials: Y
authors.lastname: Spiliopoulos
authors.forename: C
authors.initials: C
authors.lastname: Stasik
authors.forename: M
authors.initials: M
authors.lastname: Lakéhal
authors.forename: Y
authors.initials: Y
authors.lastname: Malledant
authors.forename: B
authors.initials: B
authors.lastname: Launois
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy*; D003106:Colon / Q000601:surgery; D003422:Critical Care; D003680:Deglutition Disorders / Q000601:surgery; D004322:Drainage; D004750:Enteral Nutrition; D004937:Esophageal Fistula / Q000209:etiology; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D004947:Esophagus / Q000601:surgery*; D005402:Fistula / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008026:Ligation; D008171:Lung Diseases / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D010166:Palliative Care; D011183:Postoperative Complications; D011788:Quality of Life; D013270:Stomach / Q000601:surgery*; D015996:Survival Rate; D013537:Sutures / Q000009:adverse effects; D014138:Tracheoesophageal Fistula / Q000601:surgery