Title : Early and late evaluation of palliative surgical treatment with isoperistaltic gastric tube associated with chemoradiation in advanced esophageal cancer
Abstract:
Although malignant neoplasms of the esophagus remain a very common disease, their diagnosis might often come late. This issue combined with excessive weight loss due to dysphagia and the association with cardiopulmonary diseases resulting from excessive tobacco use, makes patients with this neoplasm difficult to manage clinically, which explains why 50% of patients require palliative treatment. The ideal scenario would be the performance of procedures that provided an adequate quality of life and satisfactorily restored swallowing, without the need for further hospitalizations and with lower rates of complications. Thus, the aims to describe indications and results of palliative methods and especially diversion surgeries, discussed with emphasis on the technique of the Isoperistaltic Greater Curvature Gastric Tube (IGCGT), which was performed at the Surgery Department of Medical School Pontifical Catholic University of Campinas, Brazil. 143 patients with unresectable squamous cell carcinoma of the esophagus (stage T4b) were evaluated at this facility, but they all had clinical conditions to undergo IGCGT. In the early postoperative evaluation, 64 patients (44,7%) presented systemic complications, with pulmonary infection being the most frequent; 51 patients (35,6%) presented local complications, with cervical esophagogastric anastomotic leak being the most frequent. Thirteen patients (9,1%) died as a result of post operative complications. Out of 112 patients who were adequately followed up, 91 (81,2%) achieved good palliation with this procedure, as they had adequate restoration of swallowing function. Chemorradiation was performed after the IGCGT transposition in 82 patients, with a median survival of 3 years in 63 patients (76,8%). With the results, it is possible to conclude that despite showing non-negligible morbidity, IGCGT can be performed quickly and safely, especially after the advent of mechanical suturing, offering adequate palliation and survival rate. In addition, it has the advantage of simultaneously providing good drainage of the esophagus and stomach, thus avoiding potential esophageal mucocele.
