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Enzymatic dissection for palliative treatment of esophageal carcinoma: an experimental study

¹ Yuzuncu Yil University, Medical School, Thoracic Surgery Department, Maras Street, Van, Turkey
² Yuzuncu Yil University, Medical School, Physiology Department, Maras Street, Van, Turkey
³ Yuzuncu Yil University, Medical School, Pathology Department, Maras Street, Van, Turkey
⁴ Yuzuncu Yil University, Medical School, General Surgery Department, Maras Street, Van, Turkey

*Corresponding author. Tel.: +904322164711.

E-mail address: abaybora{at}msn.com (A. Feridun Isik).

Patients with esophageal carcinoma generally lose their chance of curable surgical treatment when symptoms become evident. At this stage chemoradiotherapy and palliative treatment methods are the only options. We investigated the potential use of enzymatic treatment in tissue loosening to improve the esophageal passage especially in patients with advanced esophageal carcinoma. Specimens were prepared from resection materials (one adenocarcinoma, two squamous cell carcinomas) which were removed from three consecutive patients. They were treated with pancreatin at 2.5%, 5% and 10% of concentrations. Macroscopic and histopathologic examinations were performed to evaluate the effect. At 2.5% enzyme concentration no macroscopically change was observed in adenocarcinoma while mild softening occurred in the tissue samples of squamous cell carcinoma. Histopathologic examination revealed tissue and cell necrosis destruction at 5 and 10% concentrations in the latter samples. We observed clear destruction of squamous cell carcinoma tissue in both macroscopically and microscopically with in vitro enzyme application. This procedure, not only helps to open esophageal passage, but may also delay the growth of tumour and support the chemoradiotherapy. Enzymatic tumoral dissection (tumourolysis) is a promising method to alleviate the symptoms of esophageal carcinoma.

Key Words: Esophagus; Cancer; Surgery; Stents; Palliative treatment