A Comparative Study on Surgical Treatment and Embolization for Esophageal Varices

Hiroshi Yoshida, Masahiko Onda, Takashi Tajiri, Matsuomi Umehara, Yasuhiro Mamada, Kiyohiko Yamashita, D.Y. Kim, Masahito Toba, Mikio Adachi, Hideki Nishikubo, Nobuhiko Taniai, Takayuki Kojima, Sakae Matsuzaki

First Department of Surgery, Nippon Medical School

Survival rates for patients with esophageal varices treated by surgery were compared with those treated by embolization. There were 127 surgically treated patients and 85 patients treated by embolization. Ten patients could not be treated by either method. These 222 patients with esophageal varices were divided into two groups: Group I, elective treatment and Child's class A or B patients; Group II, emergency treatment or Child's C patients. These 222 patients were then divided into another two groups: ∼1985, before the establishment of criteria for surgical indication; 1986∼, after establishment of the criteria. l) Before establishment of the criteria, in the Group II patients the 1-year, 3-year and 5-year survival rates were 46.7,26.7 and, 20.0%, respectively, in the surgery group and 65.9, 49.4 and 49.4%, respectively, in the embolization group. 2) In the surgery group, the l-year, 3-year and 5-year survival rates were 71.5, 56.4 and 53.6%, respectively, before establishment of the criteria and the l-year and 3-year survival rates were 91.2 and 82.9%, respectively, after establishment of the criteria. 3) In the Group II patients, the l-year,3-year and 5-year survival rates were 49.9, 32.6 and 28.8%, respectively, before establishment of the criteria and the 1-year and 3-year survival rates were 72.2 and 51.6%, respectively, after establishment of the criteria. Surgery gave poor results in the patients in Group II. Therefore these patients should be treated by embolization.

Key words
esophageal varices, embolization, surgical therapy

Reprint requests
Hiroshi Yoshida First Department of Surgery, Nippon Medical school
1-1-5 Sendagi, Bunkyo-ku, Tokyo 113 JAPAN

Accepted
June 17, 1992

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