Caustic ingestion and oesophageal cancer: intra- and peri-tumoral fibrosis is associated with a better prognosis

Ruol, Alberto; Rampado, Sabrina; Parenti, Anna; Portale, Giuseppe; Giacomelli, Luciano; Battaglia, Giorgio; Cagol, Matteo; Ancona, Ermanno

doi:10.1016/j.ejcts.2010.03.057

Cited by 20 publications

(18 citation statements)

References 8 publications

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“…However, complications such as tracheobronchial injury and necrosis, tracheoesophageal fistula, hemorrhage, perforation, aorto-enteric fistula, or gastrocolic fistula may occur in patients surviving the initial event during the first two to three weeks after ingestion [ 3 ]. Long-term complications include esophageal strictures, dysphagia, and increased risk of esophageal cancer, affecting patients’ quality of life, as well as their long-term survival [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

et al. 2016

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Case seriesPatient: Fenale, 77 • Female, 46 • Female, 33Final Diagnosis: Caustic injurySymptoms: —Medication: —Clinical Procedure: SurgerySpecialty: SurgeryObjective:Unusual clinical courseBackground:Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae.Case Report:The features of three cases of caustic ingestion are reported to demonstrate significantly different complaints presented at the emergency department. Two patients had free gastric perforation, one at presentation, and one delayed. The third patient presented with late severe strictures of the esophagus and pylorus. The outcomes of the three patients are discussed in detail along with the most current management strategies.Conclusions:Among adults, ingestion of caustic substances is usually associated with more severe lesions due to the increased amount of ingested substance, as compared with pediatric patients. The most serious presentation is that of visceral perforation, most commonly of the stomach and rarely of the esophagus. Management involves urgent resuscitation with correction of fluid and electrolyte and acid-base abnormalities and immediate surgical exploration in those patients with signs of perforation. Once the perioperative period is managed successfully, the long-term results can be satisfactory. Managing of strictures or else reconstructive procedures must be well timed to allow for psychological and nutritional rehabilitation.

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Section: Introductionmentioning

confidence: 99%

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

et al. 2016

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“…It has to be noted, though, that strong acids may cause severe tissue damage and systematic complications similar to those of alkalis [1] . Most of the patients have a history of alkaline substance ingestion taking into consideration their widespread use in the daily life and the induced complications, while acid ingestion is relatively rare [4] , [6] . Accordingly, there are only a few reports of esophageal carcinomas associated with a prior acidic injury in the literature, which may be also correlated with a different mechanism of carcinogenesis compared to alkalis [5] .…”

Section: Discussionmentioning

confidence: 99%

“…According to the medical literature, most esophageal carcinomas occur in the cicatricial tissue and the areas of anatomic narrowing, either natural ones or due to corrosive injury [1] , [6] . It has been supported that intermittent traumatic injury during dilations, food stasis and reflux of acidic content are associated with bad nutritional status and chronic inflammatory processes ultimately inducing carcinogenesis [3] , [6] . Furthermore, it has to be underlined that they tend to have a better prognosis than the rest of esophageal cancers [3] , [5] , [6] , [7] .…”

Section: Discussionmentioning

confidence: 99%

Esophageal remnant cancer 35 years after acidic caustic injury: A case report

Ntanasis‐Stathopoulos

Triantafyllou

Xiromeritou

et al. 2016

International Journal of Surgery Case Reports

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“…The interval from injury to the development of carcinoma is generally considered to be 40-50 years. In addition, Ruol et al [12] reviewed that the prognosis of cicatricial carcinoma arising in the scarred esophagus is much better than in other patients developing squamous cell carcinoma of the esophagus. This is because fibrosis might offer a protection against both local spread and nodal dissemination.…”

Section: Discussionmentioning

confidence: 97%

Pharyngo-laryngo-esophagectomy and reconstruction with a gastric tube for corrosive pharyngoesophagitis

et al. 2014

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amount consumed [1]. Corrosive ingestion may lead to serious acute complications, such as esophageal or gastric perforation, respiratory insufficiency and death. Long-term complications include scarring and stricture formation [2]. Pharyngeal anastomosis is necessary in about 10 % of these patients [3].The scarred esophagus is traditionally either resected or bypassed using a colon conduit for the esophagus [1,4], because the stomach is usually also injured by the corrosive substance. However, using a gastric conduit has also been shown to have relatively good short-and long-term outcomes [5]. However, there have been few reports that have used a gastric conduit for esophageal replacement following pharyngo-laryngo-esophagectomy for such corrosive injuries. We herein report a rare case of gastric pull-up reconstruction following pharyngo-laryngo-esophagectomy during laparotomy after gastroduodenoscopy to treat a corrosive injury. Case reportA 44-year-old male accidentally ingested an unidentified liquid. He was admitted to a local emergency hospital. He was diagnosed to have corrosive pharyngo-esophagitis associated with gastritis due to the toxic chemical substances by upper gastrointestinal endoscopy. Conservative medical treatments were started in the intensive care unit. The patient developed gradually worsening dyspnea due to upper airway stenosis. A tracheotomy was therefore performed 15 days after the accident. Dysphagia also gradually progressed, and the patient was transferred to our hospital for the purpose of surgical intervention 91 days after the accident.The laryngeal fiberscope revealed severe deformity of the larynx and hypopharynx. Both sides of epiglottis and Abstract We herein present the case of a 44-year-old male who was successfully treated with pharyngo-laryngoesophagectomy for severe corrosive esophagitis associated with pharyngitis. He accidentally ingested an unidentified liquid and subsequently developed esophagitis and progressive pharyngolaryngitis. Since he also developed dyspnea, he initially underwent a tracheotomy at an emergency hospital. Afterward, dysphagia due to hypopharingoesophageal stricture gradually developed, and the patient was referred to our hospital. Therefore, under laparotomy, a feeding tube was inserted into the jejunostomy, and the gastroendoscope inserted via the anterior gastric wall revealed that the gastric mucosa along the greater curvature was intact. Based on this information, it was concluded that the patient could undergo reconstruction with a gastric tube following pharyngo-laryngo-esophagectomy, and this was successfully accomplished 3 months later.

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Caustic ingestion and oesophageal cancer: intra- and peri-tumoral fibrosis is associated with a better prognosis

Abstract: The presence of fibrotic tissue around/within the tumour is associated with a better prognosis in SC. Fibrosis might offer a protection against both local spread and nodal dissemination.

Cited by 20 publications

References 8 publications

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

Esophageal remnant cancer 35 years after acidic caustic injury: A case report

Pharyngo-laryngo-esophagectomy and reconstruction with a gastric tube for corrosive pharyngoesophagitis

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