In patients with corrosive oesophageal stricture for surgery, is oesophagectomy rather than bypass necessary to reduce the risk of oesophageal malignancy?

Abstract

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was, 'is there an increased risk of cancer in a non-resected corrosive oesophageal stricture?' Altogether, 133 papers were found using the reported search; six papers were identified that provided the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these studies were tabulated. From the studies, 198 consecutive patients had corrosive oesophageal stricture resulting from corrosive oesophageal injury, 50 of whom (25.3%) developed oesophageal cancer. The interval between the burn and the diagnosis of scar carcinoma was 46.1 years and ranged between 25 and 58 years. The incidence of carcinoma of the oesophagus among patients from the study was significantly higher than that of the general population. In one review, seven (13%) of 54 consecutive patients treated by conservative means for caustic oesophageal stricture (COS) developed oesophageal cancer, leading to the conclusion that simultaneous resection of the oesophagus with reconstruction for such patients would provide a better probability of being completely cured of the disease. Furthermore, in patients with COS in need of operation who had a bypass procedure, it was pointed out that malignancy may develop even years after the bypass operation in the remaining part of the oesophagus and so total oesophagectomy was suggested instead of bypass. In another study, as many as 10 (31.3%) of 32 patients with corrosive oesophageal stricture developed cancer. That gave further credence to the arguments against conservative treatment or bypassing of corrosive oesophageal strictures. The risk of morbidity for intrathoracic oesophageal replacement in uncomplicated cases was 2.4%. There were basically two things that were agreed from the studies: that corrosive-induced carcinoma can occur with a reasonably high incidence if part or all of the oesophagus was left during reconstructive surgery; and that simultaneous resection of the oesophagus at the time of reconstruction in a patient with corrosive stricture offered a better outcome. The limitations of the present review were the lack of randomized controlled trials and no close follow-up.

Esophageal remnant cancer 35 years after acidic caustic injury: A case report

“…Optimal management of esophageal corrosive injuries remains a debatable issue. There has been a controversy about whether the long-term benefits of esophagectomy outweigh the possible complications [2] , [4] . Moreover, it has yet to be precisely determined whether a partial esophagectomy is sufficient enough to reduce the risk of cancer or a more radical surgical management should be followed.…”

“…The pathophysiological impact on the gastrointestinal tract and systematically varies significantly, depending on the acidic or the alkaline load along with the level of ionization and the duration of exposure [1] . As far as the management is concerned, it should be initially conservative while surgical approaches are implemented in case of complications such as perforation or stenosis [1] ; however, this issue remains controversial taken into consideration the fact that caustic ingestion significantly increases the long-term risk of esophageal squamous carcinoma development [1] , [2] . Herein, we report a case of a patient that developed squamous esophageal cancer on the ground of a caustic injury caused by ingestion of acidic substance, for which she had undergone near total esophagogastrectomy.…”

Pharyngo-laryngo-esophagectomy and reconstruction with a gastric tube for corrosive pharyngoesophagitis

“…Hopkins et al [10] reported that the prevalence of prior corrosive injury in the patients presenting with esophageal carcinoma ranged from 1.0 to 4.0 %. In another study, Okonta et al [11] reviewed 198 patients who had corrosive esophageal stricture resulting from corrosive injury, and 50 of them (25.3 %) developed esophageal cancer. The lack of large multicenter studies makes it difficult to estimate the exact risk of esophageal carcinoma after caustic injury.…”

Caustic Material Ingestion Injuries- Paradigm Shift in Diagnosis and Treatment

“…Conversely, the doubled mortality rate (11.0% vs 5.9%) of resection vs by-pass and the associated inadvertent damage to the trachea and laryngeal nerves support a conservative strategy especially in adult patients. The surgical treatment for gastric outlet obstruction is simple pyloroplasty for moderate strictures and gastrojejunostomy or partial gastrectomy for more extensive stricture [69][70][71].…”