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ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2018, Number 1

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Cir Gen 2018; 40 (1)

Palliative treatment for esophageal and cardiac cancers

Barrera OJC, Mederos CON, Castellanos GJA, Romero DCA, Cruz GP, Cruz CG

Language: Spanish
References: 22
Page: 17-23
PDF size: 656.27 Kb.


ABSTRACT

Introduction: More than 75% of the procedures performed in esophageal cancer are palliative measures; there is an ethical dilemma on how to solve the fundamental problem, which is the feeding and nutrition of the patient. Due to the fact of non-availability of esophageal prosthesis, as an alternative means we construct prosthesis with the use of other materials. Objective: To demonstrate the experience in the attention of patients with advanced esophageal and cardial cancer at the “Manuel Fajardo” University Hospital. Methods: We present 127 patients with advanced esophageal and cardial cancer, all of whom received palliative treatment during the period from 1995 to 2016 at the “Manuel Fajardo” University Hospital, therefore constituting the universe of the study. Results: In 53.54% of the cases, the tumors were predominantly localized in the third inferior portion of the esophagus and the cardias, followed by the middle third and upper third portions. Esophageal prosthesis were used in 115 patients; four were industrial self-expanding metallic prosthesis and the rest were rigid plastic ones, of which three were industrial (Heering) and 108 were handmade. Nine bypasses were carried out, as well as seven retrosternal tubular esophagogastroplasties, two esophagogastrostomies and three abdominal ostomies. Absolute alcohol was used in 20 patients before placing the prosthesis. Twelve patients had complications with the placing of the esophageal prosthesis (9.44%), with a smaller percentage among the handmade ones (8.33%); neither aspirative pneumonia nor surgical mortality occurred. Oral feeding was achieved in 97.64 % of the patients, and we observed greater life expectancy in those with bypass with isoperistaltic tubular esophagogastroplasty. Conclusions: In patients with unresectable or non-operative tumor of the esophagus and cardias, we should offer the best quality of life with a palliative treatment that excludes abdominal stomas. The construction of Teflon prosthesis, the use of absolute alcohol and bypasses are options of palliative treatment that provide an ethical solution to the conflict of these patients, with significant savings when crafting handmade prosthesis.


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