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Surgery for Caustic Injuries of the Upper Gastrointestinal Tract

Chirica, Mircea MD*; Resche-Rigon, Matthieu MD, PhD; Bongrand, Nicolas Munoz MD*; Zohar, Sarah PhDr; Halimi, Bruno MD*; Gornet, Jean Marc MD; Sarfati, Emile MD*; Cattan, Pierre MD, PhD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182583fb2
Original Articles
Abstract

Background: Surgery is the criterion standard for the treatment of severe burns and of late sequels after ingestion of corrosive agents, but long-term outcome is unknown.

Methods: Patients who underwent surgery between 1987 and 2006, for the treatment of severe caustic burns (group I, n = 268) or of late sequels (group II, n = 79) were included in the study. Survival and functional outcomes were analyzed. Functional success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. To compare the observed mortality with the expected mortality in the general population, a standardized mortality ratio (SMR) was used.

Results: Overall Kaplan-Meyer survival at 1, 5, 10, and 20 years of patients in group I was 76.4%, 63.6%, 53.9%, and 44.1%, respectively. On multivariate analysis, advanced age (P = 0.0021), extended resection (P = 0.0009), emergency esophagectomy (P = 0.013), and tracheobronchial injuries (P = 0.0011) were independent negative predictors of survival. The SMR of patients in group I was increased to 21.5 when compared to the general French population. Functional success was recorded in 147 (56%) patients in group I. Advanced age (P = 0.012), extended resection (P = 0.012), and emergency tracheotomy (P = 0.02) were independent predictors for failure. After esophageal reconstruction, patients in group II fared better than patients in group I in terms of survival (P = 0.0006) and functional success (P < 0.0001). Still, the SMR of patients in group II increased to 3.67.

Conclusions: The need to perform surgery for caustic injuries has a persistent long-term negative impact on survival and functional outcome.

In Brief

Surgery is a turning point in the lives of patients with caustic injuries of the upper gastrointestinal tract and results in the long term are still unknown. This study reports our experience with surgery for caustic injuries across a 20-year period.

Author Information

Departments of *General, Endocrine and Digestive Surgery

Gastroenterology

Biostatistics, Saint-Louis Hospital, APHP; Université Paris Diderot, Paris, France.

Reprints: Pierre Cattan, MD, PhD, Centre Hospitalier Universitaire Saint-Louis, 1 Avenue Claude Vellefaux, 75475 PARIS Cedex 10. E-mail: pierre.cattan@sls.aphp.fr.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.