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SQUAMOUS CELL CARCINOMA ESOPHAGUS IN CORROSIVE INJURED ESOPHAGUS AND PATTERN OF PRESENTATION AND PROBLEMS IN MANAGEMENT. EXPERIENCE WITH 13 CASES IN 25 YEARS
Chandramohan Servarayan Murugesan*1,2, Balakumaran Sathyamoorthy1,2, Kanagavel Manickavasagam2, Madhusudhanan Devanathan2
1Madras Medical College, Chennai, India; 2CENTER FOR GASTRO ESOPHAGEAL DISORDERS, ESOINDIA, CHENNAI, TAMILNADU, India
OBJECTIVE AND BACKGROUND
Malignancy developing in a corrosive injured esophagus has been described by many authors. Though the possibility of malignancy developing in a corrosive esophagus is expected to be around 1000 fold compared to normal individuals, no team has managed large numbers. Majority of publications are also experience in single digit even in large volume centers. The aim of this study is to analyse the pattern of presentation and problems encountered in managing
MATERIALS AND METHODS
13 patients with corrosive malignancy encountered between 1991 and 2016 were included in this study. Patients basic demographic profile, incidence, time interval between ingestion of corrosive and occurrence of malignancy, site of malignancy, symptoms at presentation, stage, management and survival were analysed.
RESULTS:
There were 10 males and 3 females. The age at presentation was between 35 and 52.The time taken between ingestion to presentation with cancer was between 13 and 29 years. The first symptom before current presentation was between 1 to 9 months. The commonest presentation dysphagia in 11 TEF in 1 UGI bleed in 1 patient. . Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoids region followed by middle (30.7%) and lower esophagus (7.75%)and OG junction (7.75%).All of them corresponds to previous site of injury. The management at the time of ingestion was dilatation in 6 patients, subcutaneous coloplasty in 5 patients, only conservative medical management in 2 patients.53.8% were locally advanced (n=7) at the time of presentation.3 cases with early cancer, 2 with metastatic disease and one with aorto enteric fistulae.6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months.
CONCLUSSION
SCC developing in a corrosive injured esophagus is a rare entity. Majority of them were presenting at a stage where curative treatment was not possible. Surgery is the treatment of choice where possible and Chemo RT is an alternative option. Survival in resectable post corrosive malignancy is good when compared to malignancy in the native esophagus.
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