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ARTICLE |

Treatment of Instrumental Perforation of Esophageal Malignancy by Transhiatal Esophagectomy FREE

Charles J. Yeo, MD; Keith D. Lillemoe, MD; Andrew S. Klein, MD; Michael J. Zinner, MD
[+] Author Affiliations

Accepted for publication Sept 29, 1987.

Reprint requests to Department of Surgery, Harvey 802, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205 (Dr Yeo).


Arch Surg. 1988;123(8):1016-1018. doi:10.1001/archsurg.1988.01400320102021
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• Perforation of esophageal malignancy secondary to instrumentation is an uncommon but catastrophic complication. Esophageal perforation at the site of an obstructing esophageal malignancy precludes simple operative repair and mandates esophageal resection with reestablishment of gastrointestinal tract continuity. In the past the standard surgical approach has involved transthoracic esophageal resection via thoracotomy. We have successfully treated four patients with perforated esophageal neoplasms by transhiatal esophagectomy and cervical esophagogastrostomy, thus avoiding thoracotomy in high-risk patients. We consider transhiatal esophagectomy an advantageous alternative in the management of selected cases of instrumental esophageal perforation adjacent to an esophageal malignancy.

(Arch Surg 1988;123:1016-1018)

REFERENCES

Foster JH, Jolly PC, Sawyers JL, et al:  Esophageal perforation: Diagnosis and treatment . Ann Surg 1965;;161:701-709.
Groves LK:  Instrumental perforation of the esophagus: What is conservative management? J Thorac Cardiovasc Surg 1966;;52:1-10.
Nealon TF, Templeton JY, Cuddy VD, et al:  Instrumental perforation of the esophagus . J Thorac Cardiovasc Surg 1961;;41:75-104.
Kerr WF:  Emergency esophagectomy . Thorax 1968;;23:204-209.
Johnson J, Schwegman CW, MacVaugh H:  Early esophagectomy in the treatment of iatrogenic perforation of the distal esophagus . J Thorac Cardiovasc Surg 1968;;55:24-29.
Turner GG:  Excision of the thoracic esophagus for carcinoma . Lancet 1933;;2:1315-1316.
Kirk RM:  Palliative resection of esophageal carcinoma without formal thoracotomy . Br J Surg 1974;;61:689-690.
Orringer MB:  Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus . Ann Surg 1984;;200:282-288.
Goldfaden D, Orringer MB, Appelman HD, et al:  Adenocarcinoma of the distal esophagus and gastric cardia . J Thorac Cardiovasc Surg 1986;;91:242-247.
Orringer MB:  Transhiatial esophagectomy for benign disease . J Thorac Cardiovasc Surg 1985;;90:649-655.
Orringer MB, Orringer JS:  Esophagectomy without thoracotomy: A dangerous operation? J Thorac Cardiovasc Surg 1983;;85:72-80.
Stewart JR, Sarr MG, Sharp KW, et al:  Transhiatal (blunt) esophagectomy for malignant and benign esophageal disease: Clinical experience and technique . Ann Thorac Surg 1985;;40:343-348.
Finley RJ, Grace M, Duff JH:  Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus . Surg Gynecol Obstet 1985;;160:49-56.

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Foster JH, Jolly PC, Sawyers JL, et al:  Esophageal perforation: Diagnosis and treatment . Ann Surg 1965;;161:701-709.
Groves LK:  Instrumental perforation of the esophagus: What is conservative management? J Thorac Cardiovasc Surg 1966;;52:1-10.
Nealon TF, Templeton JY, Cuddy VD, et al:  Instrumental perforation of the esophagus . J Thorac Cardiovasc Surg 1961;;41:75-104.
Kerr WF:  Emergency esophagectomy . Thorax 1968;;23:204-209.
Johnson J, Schwegman CW, MacVaugh H:  Early esophagectomy in the treatment of iatrogenic perforation of the distal esophagus . J Thorac Cardiovasc Surg 1968;;55:24-29.
Turner GG:  Excision of the thoracic esophagus for carcinoma . Lancet 1933;;2:1315-1316.
Kirk RM:  Palliative resection of esophageal carcinoma without formal thoracotomy . Br J Surg 1974;;61:689-690.
Orringer MB:  Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus . Ann Surg 1984;;200:282-288.
Goldfaden D, Orringer MB, Appelman HD, et al:  Adenocarcinoma of the distal esophagus and gastric cardia . J Thorac Cardiovasc Surg 1986;;91:242-247.
Orringer MB:  Transhiatial esophagectomy for benign disease . J Thorac Cardiovasc Surg 1985;;90:649-655.
Orringer MB, Orringer JS:  Esophagectomy without thoracotomy: A dangerous operation? J Thorac Cardiovasc Surg 1983;;85:72-80.
Stewart JR, Sarr MG, Sharp KW, et al:  Transhiatal (blunt) esophagectomy for malignant and benign esophageal disease: Clinical experience and technique . Ann Thorac Surg 1985;;40:343-348.
Finley RJ, Grace M, Duff JH:  Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus . Surg Gynecol Obstet 1985;;160:49-56.

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