Trans-hiatal oesophagectomy as palliative treatment for carcinoma of the oesophagus.

Objective: To determine the role of palliation with trans-hiatal oesophagectomy in Nigerian patients with carcinoma of the oesophagus.

Design: Prospective case series. The first series was from February 1986 to September 1987 (Series A) while the second series was from March 1989 to November 1996 (Series B).

Setting: Cardiothoracic Surgery Unit (CTSU) of the University College Hospital, Ibadan, Nigeria.

Subjects: First series consisted of 10 consecutive operable patients with carcinoma of oesophagus seen over the period of study. The second series consisted of 21 consecutive patients with same disease.

Intervention: All patients had transhiatal oeosphagectomy by a two team approach and immediate placement of the freed stomach in the posterior mediastinum and cervical oesophagogastrostomy.

Results: Patients in both series had a comparable age range of 43 - 80 years for series A and 40 - 82 years for Series B. The duration of symptoms were 2 - 6 months and 2 - 12 months respectively, for series A and B. In series A, nine patients had carcinoma of the middle-third (M1/3) of the thoracic oesophagus and one patient had carcinoma of lower-third (L1/3) of the thoracic oesophagus. In series B, 18 patients had M1/3 and three patients had L1/3 lesions. Average blood loss in series A was 1,067 mls, corresponding value for series B was 852 mls. Postoperatively, all cases were classified as stage III or stage IV disease. There were 18 complications in eight patients in series A and 22 complications in 10 patients in series B. The commonest complications in series A were pleural enteries in six patients, haemorrhage four patients (three intraoperative, one post-operative) and respiratory failure (two patients). The commonest in series B were pleural enteries in nine patients, anastomotic leaks and stenosis in four patients and respiratory failure in three patients. Hospital mortality was 50% in Series A and 14.3% in series B. The causes of death were haemorrhage and respiratory failure in series A, respiratory failure in series B. Survival period in series A of the five patients discharged was for a median of 84 months, for series B, four patients were alive at 18 months post-operative, one patient attended follow-up clinic 24 months after surgery. No other adjunctive therapy was offered to the patients.

Conclusion: Trans-hiatal oesophagectomy is a procedure suitable for patients with carcinoma of the oesophagus and affords palliation at an "acceptable price" among carefully selected patients with advanced carcinoma of the oesophagus.