title: Surgery for caustic injuries of the upper gastrointestinal tract.
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.
authors: Departments of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors: Mircea
authors: M
authors: Chirica
authors: Matthieu
authors: M
authors: Resche-Rigon
authors: Nicolas Munoz
authors: NM
authors: Bongrand
authors: Sarah
authors: S
authors: Zohar
authors: Bruno
authors: B
authors: Halimi
authors: Jean Marc
authors: JM
authors: Gornet
authors: Emile
authors: E
authors: Sarfati
authors: Pierre
authors: P
authors: Cattan
mesh_terms: D000328:Adult; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract / Q000293:injuries* / Q000601:surgery*; D055815:Young Adult
chemical_list: D002424:Caustics