Palliative surgery for adenocarcinoma of the gastroesophageal junction.

Adenocarcinomas of the gastroesophageal junction are usually incurable at the time the patient is first seen. The charts of 21 consecutive patients with this condition were reviewed. All had histologically documented transmural extension of tumour and lymph-node or distant metastases. A variety of surgical techniques were used to restore the ability to swallow. From the charts of these 21 cases, the authors analysed the success in restoring swallowing, the length of hospital stay, the surgical death rate, complications, survival and the ability to swallow normally at the time of death. Restoration of normal or near-normal swallowing appears to be a realistic goal. Selection of an appropriate surgical option, with resection of the primary tumour when technically feasible, allows this to be done with negligible mortality and acceptable morbidity.