Surgical treatment of perforation with esophageal carcinoma

Abstract

Perforation in esophageal carcinoma usually occurs at late stage, and is often accompanied with thoracic infections. Conventional conservative treatments, including parenteral nutritional support and stent placement under the endoscope, can neither eliminate the carcinoma nor control the infection completely. The mortality soon after perforation is fairly high. This study was to investigate the ideal operation patterns and perioperative treatment of perforation in esophageal carcinoma. A total of 41 patients with esophageal carcinoma perforated the right lung (19 cases), the mediastinum (17 cases) and the trachea (5 cases) were treated with operations: 39 underwent open thoracic operation, and 2 only underwent palliative gastric ostomy. Of the 39 patients, 16 received operation through the right thoracic approach with 3 incisions, and 23 received staging operation; 35 received retrosternal substitution of esophagus with stomach or colon, 4 underwent substitution of the esophagus with stomach via the esophageal bed. The operations were success in 36 cases. The patients could eat and take care of themselves. The patients were followed up for 3-72 months after operation: 2 survived for 3 months, 31 survived for 6-12 months, 2 survived for 24 months, and 1 survived for 72 months; 2 died during operation and 3 dead in 1 month after discharge. Of the latter 3 patients, 2 had underwent palliative gastric ostomy, 1 had stoma tracheal fistula recanalization. The surgical treatment of perforation in esophageal carcinoma could improve the survival rate and life quality of the patients. We suggest to perform retrosternal replacement of esophagus with stomach or colon through the right thoracic approach with 3 incisions or staging operations for the patients with perforation in carcinoma.