Two decades of cervical esophagostomy: indications and outcomes

Diverting cervical esophagostomy is a surgical procedure generally reserved for extremely ill patients as a life-saving maneuver. However, it is also a procedure that is infrequently performed, such that most centers have limited experience with the operation. To investigate the indications and outcomes of cervical esophagostomy, we reviewed the use of this operation at UCLA Medical Center over the last 20 years as employed for esophageal leaks. Eighteen patients underwent this procedure for the following indications: leak with malignant tracheoesophageal fistula (11%), anastomotic leak (44%), endoscopic injury (18%), gunshot wound (5.5%), operative injury (11%), corrosive ingestion (11%), and spontaneous rupture (5.5%). Overall mortality directly attributable to sepsis was 33 per cent. Of the surviving patients, 67 per cent later underwent reconstruction. Seventy-two per cent of patients had end esophagostomies, and the remainder had loop diversions. The primary indication for operation in these patients was persistent sepsis after initial surgical management of esophageal spillage into the mediastinum or neck. This series suggests that cervical esophagostomy, when applied to the appropriate patient population, can decrease mortality and allow subsequent alimentary reconstruction.