Upper digestive tract reconstruction for caustic injuries.
OBJECTIVE
The aim of the study was to compare the short- and long-term outcomes of colopharyngoplasty and esophagocoloplasty for caustic injuries of the upper digestive tract.


BACKGROUND
Simultaneous esophageal and pharyngeal reconstruction by colopharyngoplasty allows regaining nutritional autonomy in patients with severe pharyngoesophageal caustic injuries.


METHODS
Patients who underwent upper digestive tract reconstruction for caustic injuries by colopharyngoplasty (n = 116) and esophagocoloplasty (n = 122) between 1993 and 2012 were included. Survival and functional outcomes were analyzed. Success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. Quality of life was assessed using the QLQ-OG25 and SF12v2 questionnaires.


RESULTS
Overall Kaplan-Meyer survival at 1, 5, and 10 years after colopharyngoplasty and esophagocoloplasty were 92%, 74%, 67% and 92%, 83%, 73%, respectively (P = 0.56). Quality of life and functional results (success: 57% vs 95%, P < 0.0001) were impaired after colopharyngoplasty. On multivariate analysis, older age (odds ratio [OR]: 0.94; confidence interval [CI]: 0.91-0.97 P < 0.0001) and pharyngeal reconstruction (OR: 0.05; CI: 0.02-0.13, P < 0.0001) were associated with failure. The decline in success with age was more pronounced after colopharyngoplasty with only 1 (7%) of 15 patients operated after the age of 55 being self-sufficient for eating and breathing. Laryngeal resection during colopharyngoplasty had no influence on success (54% vs 58%, P = 0.67) CONCLUSIONS:: The need to associate pharyngeal reconstruction during esophageal reconstruction for caustic injuries has a long-term negative impact on functional outcome.
Departments of *General, Endocrine, and Digestive Surgery †Otorhinolaryngology, Saint-Louis Hospital, APHP, Université Paris Diderot, Paris, France.
Mircea
M
Chirica
Marie-Dominique
MD
Brette
Matthieu
M
Faron
Nicolas
N
Munoz Bongrand
Bruno
B
Halimi
Christine
C
Laborde
Emile
E
Sarfati
Pierre
P
Cattan
D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000009:adverse effects*; D003106:Colon / Q000601:surgery*; D004940:Esophageal Stenosis / Q000601:surgery; D004947:Esophagus / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007830:Larynx / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000293:injuries* / Q000601:surgery*; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D002424:Caustics