Our Summary

This research paper looks at the treatment of esophageal perforation, a serious injury in the food pipe that can potentially lead to death. The researchers examined past cases from a single institution between 1977 and 2013, comparing outcomes of emergency removal of the esophagus (esophagectomy) due to acute rupture, versus non-emergency, planned removals.

They found that patients who had emergency surgery stayed in the hospital longer and were more likely to experience complications. However, the survival rates at 30 days, 1 year, and 5 years after surgery were not significantly different between the emergency and non-emergency groups for patients with both non-cancerous (benign) and cancerous (malignant) conditions.

Within the emergency group, there was no difference in 30-day or 6-month survival based on whether the cause was benign or malignant. However, a significant difference was seen at 1 year (85% survival for benign causes versus 65% for malignant) and 5 years (72% survival for benign causes versus 21% for malignant).

The researchers concluded that emergency esophagectomy is a safe treatment option for esophageal perforation, with comparable survival rates to non-emergency esophagectomy.

FAQs

  1. What is the difference in hospital stay duration between patients who had emergency esophagectomy and those who had non-emergency esophagectomy?
  2. Is the survival rate different between patients who undergo emergency esophagectomy and non-emergency esophagectomy?
  3. Is there a significant difference in survival rates based on whether the cause of the esophageal perforation was benign or malignant?

Doctor’s Tip

One helpful tip a doctor might tell a patient about esophagectomy is to carefully follow post-operative instructions, including restrictions on diet and activities, to ensure a successful recovery and minimize the risk of complications. It is also important to attend all follow-up appointments with your healthcare provider to monitor your progress and address any concerns.

Suitable For

Patients who are recommended esophagectomy typically have serious conditions such as esophageal perforation, esophageal cancer, or other conditions that require removal of part or all of the esophagus. In the case of esophageal perforation, emergency esophagectomy may be recommended to prevent further complications and improve outcomes. Other patients who may be recommended for esophagectomy include those with esophageal cancer that has not responded to other treatments, or with severe acid reflux disease (Barrett’s esophagus) that has progressed to a precancerous or cancerous stage.

Timeline

Before esophagectomy:

  • Patients typically experience symptoms such as difficulty swallowing, chest pain, weight loss, and reflux.
  • Diagnostic tests such as endoscopy, barium swallow, and CT scans are performed to confirm the diagnosis.
  • Patients may undergo neoadjuvant therapy, such as chemotherapy or radiation, to shrink the tumor before surgery.
  • Preoperative assessments and consultations with a multidisciplinary team are conducted to prepare the patient for surgery.

After esophagectomy:

  • Patients undergo the surgical removal of a portion or all of the esophagus, often followed by reconstruction of the digestive tract.
  • Postoperative complications such as infection, leakage, and narrowing of the new connection (anastomotic stricture) may occur.
  • Patients require intensive postoperative care in the hospital, including monitoring for potential complications and rehabilitation to regain swallowing function.
  • Long-term follow-up care is necessary to monitor for recurrence of cancer and manage any long-term side effects of the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about esophagectomy may include:

  1. What are the potential risks and complications associated with esophagectomy?
  2. How long is the recovery process expected to be after esophagectomy?
  3. Will I need any additional treatments or therapies after the surgery?
  4. How will my diet and eating habits be impacted after esophagectomy?
  5. What is the long-term outlook for survival and quality of life after esophagectomy?
  6. Are there any alternative treatment options to consider before proceeding with esophagectomy?
  7. How experienced is the surgical team in performing esophagectomy procedures?
  8. What can I do to prepare for the surgery and optimize my chances for a successful outcome?
  9. Will I need any follow-up appointments or monitoring after the surgery?
  10. Are there any support resources or organizations available for patients undergoing esophagectomy?

Reference

Authors: Seo YD, Lin J, Chang AC, Orringer MB, Lynch WR, Reddy RM. Journal: Ann Thorac Surg. 2015 Sep;100(3):905-9. doi: 10.1016/j.athoracsur.2015.04.055. Epub 2015 Jul 16. PMID: 26188974