Conservative management of iatrogenic esophageal perforation in head and neck cancer patients with esophageal stricture

• Published in: Otolaryngology-head and neck surgery 2009-04, Vol.140 (4), p.505-511
• Main Authors: Mao, Johnny C., Kayali, Foaz M., Dworkin, James P., Stachler, Robert J., Mathog, Robert H.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Cohort Studies; Dilatation - adverse effects; Esophageal Perforation - etiology; Esophageal Perforation - therapy; Esophageal Stenosis - etiology; Esophageal Stenosis - surgery; Female; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Iatrogenic Disease; Male; Middle Aged; Retrospective Studies; Treatment Outcome
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1016/j.otohns.2008.12.052

Evaluate the efficacy of conservative management of iatrogenic esophageal perforation following dilatation of a stricture secondary to the treatment of head and neck cancer. Case series with chart review. Retrospective chart review of 24 patients with esophageal perforation treated at the Detroit Medical Center from 1999 to 2008. Of these, eight head and neck cancer patients had esophageal stricture and underwent dilatation with subsequent esophageal perforation. Six patients were managed conservatively; two were managed surgically. All eight patients had radiation, six had chemotherapy, and five had surgery as part of their oncologic treatment. Stricture site was at the cricopharyngeus or neopharynx. Perforation size was estimated at 3 to 7 mm in conservative patients and approximately 10 mm in surgical patients. All patients survived to be discharged from the hospital and diet was tube feeds. In head and neck cancer patients with post-treatment esophageal stricture, iatrogenic cervical esophageal perforations can often be safely managed conservatively. The criteria are: prompt diagnosis within one hour, small perforation (3-7 mm), penetrating type of perforation with circumferential mucosal contact, proximal or cervical esophageal location, and stabilization and improvement of clinical signs and symptoms for 24 hours after initial ICU management.