01.10.2012 | Review
Resection or bypass in the treatment of corrosive oesophageal strictures? Malignant transformation as a late complication in both methods
Erschienen in: European Surgery | Ausgabe 5/2012Einloggen, um Zugang zu erhalten
During the surgical treatment of corrosive oesophageal strictures, one of the most important decisions to make is, whether the injured and scarred oesophagus should be removed or bypassed. Resectional approach is justified by the high frequency of scar cancer developing in the injured oesophagus. On the other hand, according to advocators of bypass surgery, the risk of malignant transformation in the oesophagus excluded from the food passage is negligible, when bypass is performed within few years of injury. There are very few data on the risk of cancer in the remaining oesophagus following resection, and in the replacement organ in case of bypass.
On three cases—one skin tube cancer in the replacement organ 21 years following injury, one colon cancer in the replacing colon 44 years following injury and one oesophageal scar cancer in the remnant oesophagus 28 years following injury—three different types of late malignisation in the remaining oesophagus as well as in different organs used for oesophageal replacement are demonstrated.
Malignant transformation is rarely but equally occurs in the remnant oesophagus following caustic injury and in the different organs used for replacement.
In this debate, there are more controversies than consensus.