Results of the Kirschner operation

Abstract

Between 1964 and 1979, a total of 1,536 patients with carcinoma of the thoracic esophagus were treated at the authors' center. Of these, 142 patients with unresectable tumor underwent the Kirschner operation for palliation. In this operation, esophageal obstruction is bypassed by subcutaneous or retrosternal gastric esophagoplasty, and the thoracic esophagus defunctionalized by a long Roux-en-Y jejunal loop to the abdominal esophagus. Dysphagia is thus relieved and aspiration of esophageal and gastric contents into the respiratory tract avoided. Any patient who was not discharged from the hospital for any reason and eventually died in the hospital is counted as a mortality. The hospital mortality for these 142 patients was 41.5% (59 patients). In recent years there has been a reduction in mortality rate. The most common cause of death was progressive bronchopneumonia (72.9%). Leakage of anastomosis occurred in 67 patients (47.2%), but most healed on conservative treatment. The ability to eat normally was restored in 69% of survivors, and another 28% were able to tolerate a soft diet. Although temporary postoperative aspiration was occasionally encountered when the patient started oral feeding, once swallowing was established, tracheobronchial aspiration did not occur. The mean survival of the discharged patients was 5.0 months. Malignant cachexia from growth of the primary tumor accounted for 61.4% of late deaths; metastatic disease, 10.8%; and cardiopulmonary insufficiency, the remainder. One patient is alive more than 5 years after operation, and presumably was cured by postoperative radiotherapy. Although the mortality rate of the Kirschner operation is substantial, other forms of treatment also have significant mortality rates but with less palliative potential. Therefore, we would recommend this operation for the palliation of unresectable carcinoma of the esophagus.