D. Karat

Spontaneous rupture of the oesophagus

The aim of this study was to evaluate the diagnosis, management and outcome of patients with spontaneous rupture of the oesophagus in a single centre.

Radical lymphadenectomy in the management of early gastric cancer.

Lymph node metastasis in patients with early gastric cancer was evaluated prospectively to determine whether radical (D2) lymphadenectomy is appropriate in such cases. Twenty-eight (18 per cent) of 156 patients having surgery for gastric cancer had early disease. Lymph node metastasis was found in 12 of the 28 patients. Metastasis was more likely in submucosal than mucosal early gastric cancer (nine of 14 versus three of 14; P = 0.024, Fishers exact test). In two of three patients with metastasis at the N2 level, the N1 nodes were entirely clear. This study shows a higher incidence of lymph node metastasis than has been reported previously in both the UK and Japan. The high incidence of lymph node metastasis in early gastric cancer supports the continuing use of radical lymphadenectomy in patients who are fit for such major surgery.

Outcome, survival, and costs in patients undergoing intubation for carcinoma of the esophagus

BACKGROUND In this prospective study a consecutive series of 70 patients undergoing insertion of a Wilson-Cook endoprosthesis for palliation of esophageal carcinoma was examined. METHODS The tube was inserted endoscopically using intravenous sedation and a pulsion technique. RESULTS The patients had a mean (SEM) age of 70.7 (1.5) years and 44 (63%) were men. Two patients died in hospital and 2 died after discharge, giving a procedure-related mortality of 2.8% and a 30-day mortality of 5.7%. Nine patients experienced complications, giving a morbidity rate of 12.8% following the initial procedure. Twenty patients required a second or further procedure. The indications were tube migration in 22 cases, obstruction in 10, and fistula formation in 2 patients. Thirty-day mortality in this group was significantly greater than after a first procedure (7 patients, 20.1%; P <0.05). The median survival following insertion of a Wilson-Cook endoprosthesis was 16 weeks. CONCLUSIONS This study describes a safe, effective method for insertion of an endoprosthesis, with a low morbidity and mortality. The average cost for endoscopic insertion of a Wilson-Cook endoprosthesis in this unit is

Quality-of-life assessment in patients undergoing treatment for oesophageal carcinoma

1,600, and in view of the short median survival in this group of patients, the introduction of costly self-expanding stents is not warranted without demonstrable benefits in a controlled, prospective, randomized clinical trial.