Which of the following statement(s) is/are true concerning nonresectional therapy for esophageal carcinoma?

c. Endoscopic laser fulguration is successful in up to 75% of patients

d. There is little or no role for surgical bypass for unresectable esophageal carcinoma

Therapy of esophageal carcinoma is influenced by the knowledge that in most of these patients, local tumor invasion or distant metastatic disease preclude cure. While squamous cell carcinoma is generally regarded as a radiosensitive and therefore potentially curable tumor, radiation therapy has not achieved cure in most patients. Although “curative” super voltage radiation techniques have been employed, the average five-year survival after such treatment is between 6 and 10% in most series. This is somewhat poorer than five-year survival rates after resection which usually range between 10 and 15%. A variety of endoesophageal tubes have been used for palliation in patients with esophageal carcinoma. Basically, these tubes are divided into two types: the pulsion tubes, which are pushed through the tumor with the aid of an esophagoscope; and the traction or pull-through tubes, which are pulled into place by downward traction through a gastrostomy. As in the case with many conceptually simple procedures, implementation in the clinical setting is problematic. Transoral esophageal intubation is associated with an overall mortality of 14% and a complication rate of 25%, the latter due to perforation of the esophagus, migration of the tubes, or obstruction of the tubes by food or tumor overgrowth. More recently, a variety of expandable intraesophageal metallic stents have been used to achieve palliation in patients with unresectable esophageal carcinoma. Additional expertise with this technique is being acquired through a multiinstitutional trial currently underway in the United States. Endoscopic laser fulguration of esophageal carcinoma has been used to achieve temporary relief of the esophageal obstruction in patients with unresectable tumors. Generally, multiple sessions are required to resect sufficient tumor to achieve adequate lumen, but functional success with restoration of a comfortable volume can be achieved in 75–80%. Although a variety of surgical procedures such as substernal gastric or colon bypasses have been developed as palliative internal bypasses of unresectable esophageal carcinoma, the limited survival in these unresectable patients can be high and the mortality rates, between 15 and 25%, do not currently justify their use.