[Late malignant transformation of chronic corrosive oesophageal strictures]

The number of patients with scar carcinoma of the oesophagus developing on the basis of a corrosive stricture seems to be rising in the past decades. Thirty six patients with this condition were treated surgically in a 20 years period; this is the second largest series in the literature. Patients with scar cancer were 7.2% of all oesophageal carcinoma cases; this ratio is currently the highest of all in the literature. The interval between the burn and the diagnosis of scar carcinoma was 46.1% years; this is higher than the 30-35 years generally described so far. It was 50.9 years in those patients who drank lye before the age of 12, but 14 years less when it happened in adulthood. The long-term survival was excellent: 45.6% of the patients after resection were alive after 5 years and 14.4% after 10 years. The explanation of the good prognosis is that carcinoma develops in a lye stricture and is at first surrounded by a rigid scar which allows only intraluminal growth, so it causes early dysphagia through obstruction. Early dissemination is prevented because of the same reason. One-stage resection and reconstruction is the best way to treat the radically operable patients. In patients with esophageal corrosive stricture in need of operation, both a bypass procedure and resection can be performed, but it should be pointed out that malignancy may develop even years after the operation in the remaining part of the gullet. Total esophagectomy is therefore suggested instead of by-pass.