Factors associated with rapid progression to esophagectomy for benign disease

The reasons why some patients with benign esophageal diseases require esophagectomy remain poorly understood. In this study we sought to define the rate of progression to esophagectomy and the postesophagectomy outcomes of patients with benign esophageal conditions in whom 1 or more previous interventions failed.

Using a prospective database, we retrospectively identified patients who had esophagectomies for benign disease between 1978 and 2010. Patients who underwent 1 or more esophageal interventions before resection met inclusion criteria. We examined factors associated with progression to esophagectomy and with postesophagectomy complications.

One hundred eleven patients underwent 1 or more esophageal interventions before esophagectomy. The most common indications for initial intervention were achalasia (37%, n = 41) and gastroesophageal reflux (33%, n = 37). More rapid progression to esophagectomy was associated with acquired esophageal disease (p < 0.01), initial esophageal intervention at age ≥ 18 (p < 0.01), and previous fundoplication (p = 0.03). Complications of esophagectomy included 30-day mortality (n = 2, 1%), chylothorax (n = 4, 3%), anastomotic leak (n = 17, 11%), and reoperation (n = 17, 11%).

These findings highlight the importance of increased awareness of the potential progression to esophagectomy during repeated procedural interventions for benign esophageal disease. A subset of the patients who progress more rapidly, including adult patients and those with acquired disease and/or previous fundoplication, may benefit from counseling about potential esophagectomy.