[Development of scar cancer after subtotal oesophagectomy for corrosive injury]

Corrosive induced carcinoma of esophagus after 58 years

Patients with corrosive induced esophageal strictures have an increased risk of esophageal carcinoma. We present a case of a 61-year-old man who ingested sulfuric acid at the age of 3 years and then developed dysphagia at late follow-up. In 2010, he presented to the outpatient clinic with weight loss and worsening dysphagia to both solids and liquids. A barium swallow radiograph and endoscopy demonstrated a long stricture in the middle third of the esophagus. Ivor-Lewis esophagectomy was undertaken via an upper midline abdominal incision and a right thoracotomy, and pathologic examination of the resection specimen confirmed a well-differentiated esophageal squamous cell carcinoma. Twenty-two months postoperatively, he reports no dysphagia, and no tumor recurrence was evident during follow-up.

Antesternal colonic interposition for corrosive esophageal stricture

Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. Antesternal, retrosternal, or esophageal bed passage are the routes described. In the present series, the data of antesternal colonic interposition (ACI) performed for nondilatable benign esophageal strictures in 32 patients (1988-2011) have been retrospectively analyzed. The results indicate that ACI for corrosive strictures is a quick and simple procedure. Thoracotomy is avoided and anastomosis is easily performed in the neck, and mortality rate due to anastomotic failure or graft failure is diminished. This retrospective analysis discusses the ease, effectiveness, quality of life, morbidity, and mortality of ACI and compares the pros and cons of ACI with other procedures described in the literature.