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Oesophageal resection after instrumental perforation.
S C Griffin1, J Desai, E R Townsend
1Department of Thoracic Surgery, Harefield Hospital, Middlesex, UK.
Summary
Esophageal resection following endoscopic perforation is a high-risk procedure, particularly for cancer patients. While life-saving for benign strictures, operative mortality remains significant due to respiratory failure.
Area of Science:
- Surgery
- Gastroenterology
- Thoracic Medicine
Background:
- Endoscopic procedures can lead to esophageal perforation.
- Perforation of the esophagus, especially the thoracic portion, presents significant risks.
Purpose of the Study:
- To evaluate the outcomes of esophageal resection after endoscopic perforation.
- To assess the mortality and complication rates associated with this surgical intervention.
Main Methods:
- Retrospective review of 11 patients undergoing esophageal resection for endoscopic perforation (1981-1987).
- Analysis of patient demographics, underlying conditions (cancer vs. benign strictures), timing of resection, and postoperative outcomes.
Main Results:
- Operative mortality was 36.3% (4/7) in cancer patients versus 0% in benign stricture patients.
- Respiratory complications, leading to respiratory failure, were the most common cause of death.
- Resection within 24 hours was performed in 7 patients, while 4 were resected between 2-10 days post-perforation.
Conclusions:
- Esophageal resection following perforation, particularly in cancer cases, carries a high mortality rate.
- While potentially life-saving for benign strictures, the procedure remains high-risk.
- Respiratory failure is a critical postoperative concern requiring careful management.