Bypass laparoscopic procedure for palliation of esophageal cancer
A 69-year-old male presented with progressive dysphagia, retrosternal pain and weight loss of 10 kg in 2 months. An upper endoscopy was scheduled for further evaluation. The finding was a circumferential lesion from 19 to 25 cm of the incisors, with biopsy diagnosing squamous cell carcinoma. Radiological examinations showed lymphadenopathy in the celiac trunk and in the mediastinal area. A bronchoscopy diagnosed tracheal infiltration by neoplasia.\nThe patient was treated with external radiotherapy (13 × 250 cGy) with symptom relief and regained performance status (from 3 to 1). However, after re-staging exams, the persistence of the disease was diagnosed, with dysphagia worsening. Surgical palliative treatment was proposed, using the laparoscopic approach for symptom relief.\nThe technique, as described by Lacerda et al. in a previous report [], involves the creation of a gastric tube close to 3 cm in width and with an average length of 30 cm (Fig. ) and preservation of the right gastroepiploic vessels by laparoscopy.\nThe tube is then passed along a retrosternal path and end-to-side anastomosis using a circular stapler is performed with the cervical esophagus prepared earlier by left cervicotomy. A laminar drain is applied in the cervical incision (Fig. ).\nThe patient was discharged from the hospital on the fifth post-operative day with oral intake. No leakage or other complication was found during the post-operative period. The patient survived for 4 months, gained 10 kg in this period and did not refer any dysphagia after the procedure.