The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 11-14, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Neodymium:yttrium-aluminum-garnet laser vaporization for palliation of obstructing esophageal carcinoma
BC Moon, IK Woolfson and CD Mercer
Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada.
Palliative therapy for obstructing esophageal carcinoma is more often
necessary than curative surgery. The neodymium:yttrium-aluminum-garnet
laser was used for vaporization of obstructing esophageal carcinoma in 18
patients requiring 24 treatments. Three women and 15 men (age range 42 to
87 years) had esophageal carcinoma (seven squamous cell and nine
adenocarcinoma). Twelve tumors were at the esophagogastric junction, four
at the midesophagus, and two in the cervical esophagus. Lengths varied from
3 to 7 cm. Inoperability was due to diffuse metastases in eight patients,
local invasion in five, poor operative risk in one patient, and patient
refusal for operative treatment in four patients. Energy use was 1000 to
22,600 J per session (mean 6120 J). Good results were achieved in 16
patients (88.9%): Seven returned to full diet, five to soft diet, and four
to full fluids without dysphagia. Four patients required retreatment 1 to 3
months later because of recurrent dysphagia. One patient was not benefited
by the treatment and died of carcinomatosis 1 week later. No intraoperative
complications occurred. Postoperatively, one patient had laryngeal edema
and another had a bronchoesophageal fistula 3 weeks later. The mean
survival time is 3 1/2 months. Neodymium:yttrium-aluminum-garnet laser
vaporization for obstructing esophageal carcinoma is effective palliation
regardless of histologic tumor type. It can be performed under direct
vision with a low frequency of postoperative complications.
