Oesophagus

Oesophageal cancer frequently presents late and with incurable disease; therefore, knowledge and experience in palliative techniques are essential. Clinical policy on palliative surgery is generally determined by the local cancer network with individualised treatment agreed at a multidisciplinary meeting. Despite advances in perioperative care and meticulous patient selection, oesophagectomy remains a morbid procedure, and today palliative oesophagectomy is rarely performed, if at all. The most troublesome symptoms of incurable oesophageal cancer, namely, dysphagia and bleeding, can now be successfully alleviated using less invasive methods. Oesophageal self-expanding stents, brachytherapy, external beam radiotherapy and endoscopic recannulation techniques are highly effective as unimodal or multimodal therapy and are well tolerated by patients with minimal side effects. As such, they form the backbone of modern palliative oesophageal surgery.Benjamin C. Knight and Glyn G. Jamieso