1990 Volume 12 Issue 1 Pages 73-81
To analyze the correlation between the fiberoptic bronchoscopic findings and the treatment and the prognosis in cases of advanced esophageal carcinoma with tracheobronchial involvement, pre-operative bronchoscopy was performed on 147 patients. Bronchoscopic findings could be classified into five types based on the grade of tracheobronchial invasion. In type I[++], tracheobronchial obstruction or stenosis caused by the polypoid tumor of esophageal carcinoma was observed. In type II[+], there was evidence of both protrusion of tracheobronchial wall and abnormal findings of the mucosa such as thickening of longitudinal folds, irregularity and/or redness of the mucosa, and engorgement of mucosal blood vessels. In type IIIa[+-] and type IIIb[+-], either protrusion of tracheobronchial wall with normal mucosa or abnormal findings of the mucosa was present. In type IV[-], no abnormalities were definable. Type I was found in 9 patients (6%) out of 147, II in 36 (24%), III in 6 (4%) and IV in 91 (66%). Out of the 9 patients with type I, one had bypass operation without thoracotomy and 8 radiotherapy or conservative therapy. Out of 36 with type II, 22 had surgical therapy (7 curative resection, 6 non-curative resection, 3 bypass operation with thoracotomy and 6 bypass operation without thoracotomy), 14 radiotherapy. Out of 6 with type III, 5 had surgery and one radiotherapy. One year survival rate was 13.3% in type I, 28.8% in type II, 53.3% in type IIIa and 50.0% in type IIIb. In conclusion, pre-operative bronchoscopy seems to be very important in assessing the sites and the grade of tracheobronchial involvement, indication of surgery and prognosis of advanced esophageal carcinoma.
