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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twelve cases of superficial carcinoma of the esophagus, representing 4.9% of patients with carcinoma of the esophagus, were evaluated. All the patients were male smokers who drank alcohol excessively. The main clinical features were dysphagia, asthenia, anorexia, and weight loss. Most of the lesions were elevated and all endoscopic biopsies were positive for cancer. Half of the cases showed invasion of the submucosa; the remainder involved mucosa only. Ten patients are alive and free of metastatic disease.
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PMID:Superficial esophageal carcinoma: a report of 12 cases. 399 61

The number of patients with scar carcinoma of the oesophagus developing on the basis of a corrosive stricture seems to have been rising in the past two decades. 36 patients of this kind were treated surgically between 1965 and 1984; this is the second largest series in the literature. The patients with scar cancer comprised 7.2% of the overall oesophageal carcinoma cases; this ratio is currently the highest of all in the literature. The interval between the caustic burn and the diagnosis of scar carcinoma was found to be 46.1 years; this is higher than the 30-35 years generally accepted so far. It was 50.9 years in those patients who drank lye before the age of 12, but 14 years less when it happened in adulthood. The long-term survival time proved to be excellent: 45.6% of the resected cases were alive after 5 years and 14.4% after 10 years. The explanation of the good prognosis lies in the fact that carcinoma developing in a lye stricture is at first surrounded by a rigid scar which allows only its intraluminal growth, and it causes early dysphagia through luminal obstruction. Early dissemination is prevented for the same reason. One-stage resection and replacement is suggested in the radically operable cases. In patients with oesophageal corrosive stricture which needs operation, both a by-pass procedure and resection can be adopted, but it should be pointed out that malignancy may develop even years after the operation in the remaining part of the gullet. Total oesophagectomy is therefore suggested instead of bypass.
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PMID:Late malignant transformation of chronic corrosive oesophageal strictures. 408 89

Therapy for carcinoma of the esophagus and cardia is primarily palliative, since cures are uncommon. Palliation is best achieved by an aggressive surgical approach using esophagogastrectomy and esophagogastrostomy whenever possible. The surgical technique for these procedures is described in detail. Permanent relief from dysphagia is achieved in almost 90 per cent of patients who undergo operation.
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PMID:Esophagogastrectomy for carcinoma: technical considerations based on anatomic location of lesion. 615 8

The authors review their experience with primary resection for carcinoma of the esophagus and compare the palliative results with those of a recently reported series of similar patients treated with radiotherapy alone. Between 1971 and 1977, 104 patients with carcinoma of the esophagus underwent resection as the primary therapy. The operative mortality was 7.7% (1.7% in the latter half of the series). At least 80% of the 104 patients had complete, continuing palliation of their dysphagia. Radiotherapy in a similar group of patients reported resulted in an 8% mortality from complications of the treatment and there was local recurrence of the tumour, usually associated with dysphagia, in 80%. The authors conclude that the palliation achieved with surgical resection is substantially better than that achieved with radical radiotherapy applied to a similarly staged group of patients with carcinoma of the esophagus.
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PMID:The palliative value of surgical resection for carcinoma of the esophagus. 616 60

The distressingly low resectability rate of carcinoma of the oesophagus and gastric cardia emphasises the need for palliative restoration of the act of swallowing. Side-to-side oesophagogastrostomy was performed in 10 cases of unresectable tumours. Eight anastomoses were made low in the left chest for lower third oesophageal and cardiac lesions and two high on the right for midoesophageal tumours. There were no anastomotic leaks or other complications, and no postoperative deaths. All patients swallowed well for an average of five months until their deaths. The decision to use this procedure is made at the time of thoracotomy when resection of the cancer is impossible because of local invasion and when sufficient proximal oesophagus is available for the anastomosis. The operation involves a single suture line only. It provides immediate palliation of dysphagia and makes unnecessary additional technical manoeuvres such as preparation of colonic or jejunal loops insertion of endoluminal tubes, or even transection of the oesophagus, pyloroplasty, gastrostomy or cervical oesophagostomy. It does not interfere with any subsequent radiotherapy or chemotherapy.
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PMID:Palliative side-to-side oesophagogastrostomy for unresectable carcinoma of the oesophagus and cardia. 617 3

Of 262 patients with carcinoma of the esophagus or cardia seen at the Lahey Clinic between January 1970 and January 1983, 209 (79.8%) underwent surgical exploration. This report is confined to the 167 operations performed in the division of the senior author. Half of the tumors involved the esophagogastric junction with nearly equal numbers being located in the lower and upper halves of the thoracic esophagus and a relatively small number involving the cervical esophagus. The majority were adenocarcinomas of which 20 developed in a Barrett esophagus. Three of the squamous cell cancers developed in an achalasic esophagus. Of the resected tumors, 94 were classified as Stage III, 18 as Stage II, and 37 as Stage I. Esophagogastrectomy with esophagogastrostomy is the procedure of choice regardless of the level of the lesion. Of the 167 patients, 149 (89.2%) underwent resection with two deaths within 30 days of operation for a hospital mortality rate of 1.3%. There were 22 major complications (14.9%), which prolonged the hospital stay, and 14 minor complications (9.5%). Satisfactory palliation of dysphagia was achieved in 82.7% of the patients. The overall adjusted survival rate at 5 years was 21.7% +/- 7.5% (SEM) with a median survival time of 17.3 months. The 5-year adjusted survival rate according to stage was 43.4% for patients with Stage I lesions, 23.6% for Stage II lesions, and 12.8% for Stage III lesions (p = 0.0004). A multivariate analysis of risk factors involved in survival disclosed that neither age, sex, site of tumor, duration of symptoms, or cell type influenced survival, but stage of the disease had a profound effect. It is concluded that long-term survival of patients with carcinoma of the esophagus or cardia will probably not improve until early diagnosis is possible and that esophagogastrectomy by conventional techniques should be the treatment of choice until other forms of therapy prove superior to it both in terms of palliation and long-term survival.
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PMID:Esophagogastrectomy. A safe, widely applicable, and expeditious form of palliation for patients with carcinoma of the esophagus and cardia. 619 63

The palliative treatment of esophageal carcinoma has included intubation, bypass, dilation, irradiation, and esophagogastrectomy. The last has been criticized by some on the basis of high operative morbidity and mortality. To assess the success of this method at our institution, we reviewed the 60 consecutive resections performed for carcinoma of the esophagus from January, 1972, through June, 1983. Forty-six patients had squamous cell tumors and 14, adenocarcinomas. There were 47 men and 13 women, and the mean age was 59.9 years (range, 38.5 to 78.9 years). The most frequent preoperative findings included dysphagia (55), weight loss (34), chest pain (22), and vomiting (49). Fifty (83%) out of the 60 resections were performed by the resident staff under the supervision of an attending surgeon. Four patients died within 30 days of operation, an operative mortality of 6.7%. Immediate causes of death included respiratory failure, myocardial infarction, hemorrhage, and renal failure. One of the patients who died and 3 of the survivors had an anastomotic leak. There were 27 additional complications in 24 patients: respiratory problems (8), arrhythmias (5), pleural effusion (4), gastric outlet obstruction (2), wound infection (2), and 1 each of pulmonary embolus, acute brain syndrome, congestive heart failure, myocardial infarction, chylothorax, and empyema. The one-, two-, three-, and five-year actuarial survival rates were 46%, 27%, 10%, and 5%, respectively. Mean survival for the 46 patients dead at the time of this study was 13.5 months. Outpatient follow-up data were available on 53 (95%) of the operative survivors and showed an absence of dysphagia in 87.5% during most of the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Esophagogastrectomy as palliative treatment for esophageal carcinoma: results obtained in the setting of a thoracic surgery residency program. 621 66

This report describes our experience with six patients with dysphagia as the sole manifestation of radiographic, inconspicuous primary lung cancer and well-defined esophageal lesion by barium swallow. Esophagograms suggested leiomyoma, benign esophageal stricture, duplication cyst, achalasia, and primary carcinoma of the esophagus. Careful evaluation of the chest radiographs in all patients presenting with dysphagia is emphasized. The majority of esophageal findings are subcarinal and bronchoscopy should be considered essential in the workup of these patients.
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PMID:Bronchogenic carcinoma masquerading as primary esophageal disease. 628 56

The coexistence of malignancy and dysphagia makes nutritional deprivation especially serious in patients with carcinoma of the esophagus. Intravenous hyperalimentation (IVH) is often given and should be of particular value in these patients. Sixty-four patients with carcinoma of the esophagus seen between January, 1975, and February, 1982, were studied retrospectively during their first hospitalization for the disease. Thirty-seven patients received IVH, and 27 did not. There were no significant differences at the time of admission to the hospital between the two groups with respect to age, sex, pathological status, and location of the carcinoma. Also, there was no difference in the incidence of hypoalbuminemia (less than 3 gm/dl) or lymphocytopenia (less than 1,500/mm3). More patients in the IVH group underwent surgical resection of the esophagus. Surgical intervention did not significantly influence hospital mortality. The IVH therapy reduced weight loss (p less than 0.05), but was associated with an increased incidence of pulmonary sepsis (p less than 0.05) and longer hospital stay. The incidence of hypoalbuminemia and lymphocytopenia increased between admission and the end of hospitalization, but it did not significantly differ between the groups. Thus, one cannot assume the effectiveness of IVH in this clinical setting, as its value was not demonstrated in this retrospective series. A prospective randomized study is warranted in view of the high cost and the doubtful clinical impact of an IVH regimen in patients with carcinoma of the esophagus.
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PMID:Clinical impact of intravenous hyperalimentation on esophageal carcinoma: is it worthwhile? 643 36

Nine of 168 patients (5.3%) with carcinoma of the esophagus had primary tumors in the cervical esophagus. The principal symptoms and signs of carcinoma of the cervical esophagus were dysphagia, hoarseness, neck mass, and weight loss. The esophagogram was a very reliable study, revealing the abnormality in all nine patients. The true extent of the disease was better delineated by computerized tomography which demonstrated not only the intraluminal mass but also the extraesophageal spread. Endoscopic examination of the cervical esophagus was the definitive procedure to establish the diagnosis. All nine patients were treated with definitive radiotherapy, three surviving two to five years. The major cause of death was the failure to control local disease.
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PMID:Carcinoma of the cervical esophagus: diagnosis, management, and results. 649 55


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