ESOPHAGOGASTRECTOMY FOR IATROGENIC PERFORATION OF ESOPHAGEAL AND CARDIA CARCINOMA

A casenote review identified 18 patients with carcinoma of the oesopha gus and gastric cardia who underwent transthoracic oesophagectomy afte r instrumental perforation. Oesophagectomy was performed within 48 h i n ten patients (early surgery group) and after a median delay of 22 (r ange 5-48) days in eight patients (delayed surgery group). All patient s underwent resection via left thoracolaparotomy with immediate intrat horacic anastomosis using the stomach in 17 of 18 patients. There were no anastomotic leaks. Significant postoperative complications occurre d in five of ten of the early group with two in-hospital deaths and a mean survival of 551 days. Six of eight patients in the delayed group developed postoperative complications with two in-hospital deaths and a mean survival of 297 days. Transthoracic resection with immediate in trathoracic anastomosis can be performed without anastomotic leakage b ut there is high associated respiratory morbidity. The timing of oesop hagectomy has little effect on hospital morbidity or mortality rates b ut early surgery is associated with better long-term survival.