• Journal of Chest Surgery
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• v.28 no.11
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• pp.1032-1037
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• 1995

Between September 1988 and December 1993, 32 cases of benign esophageal stricture, of which 12 males and 20 females, were managed in Seoul National University Hospital hospital. Their age ranged from 2 to 61 years, and the mean age was 33.9 years. The ingestion of caustic agent was the most common cause, and the caustic material was acid in 16 patients [58% and alkali in 11patients [39% . Nearly all of the patients complained of dysphagia, and some of chest pain, epigastric pain, weight loss, vomiting, general malaise, and dyspnea. The most frequent site of stricture was found in the upper thoracic esophagus with 34% incidence followed by the lower thoracic esophagus[28% , whole esophagus[19% , and the mid esophagus[16% . The operations performed were 17[53% ECG[esophagocologastrostomy , 5[16% PCG[pharyngocologastrostomy , 5[16% EG[esophagogastrostomy , 2 EJG [esophagojejunogastrostormy by free jejunal graft , and 1 case each of EJ [esophagojejunostomy , esophageal end to end anastomosis, jejunostomy only, and gastrostomy only. In 23 patients [72% , diseased esophaguses were resected, using transhiatal total esophagectomy in 15 [47% and transthoracic partial esophagectomy in 8 [25% . Of those 23 patients, 3 patients [9.4% were diagnosed as esophageal carsinoma on microscopic examination. The postoperative most common complications were unilateral vocal cord palsy in 6 patients [19% , followed by cervical anastomosis leakage in 4 patients [12.5% , wound infection in 2 patients [6% , and pneumothorax in 2 patients [6% . Late death occurred 8 months after the operation in one patient, which was associated with infection due to anastomotic leakage. Our experience shows that the rate of mortality and the morbidity were low in patients receiving surgical management for esophageal stricture and that the cancer transformation rate was high. We recommend esophageal reconstruction surgery with esophagectomy [transhiatal or transthoracic for the esophageal stricture because it can avoid a chance of prevent cancer transformation.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.515-521
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• 1991

Since Carrel in 1907 reported transfer of a free jejunal segment in dog, reconstruction of the cervical esophagus and hypopharynx has been accomplished successfully with free jejunal transplantation using microvascular technique. Free jejunal graft is useful in cases of failed colonic interpositions. Three patients with benign esophageal stricture had undergone reconstruction with right colon interposition. Because of necrosis and stricture of the interposed colon, in each case the defect was reconstructed with a free jejunal graft by using microvascular technique. The postoperative course in two patients was uncomplicated, and they were able to eat general diet. Graft necrosis occurred in one patient, but she is waiting for a reoperation.

• Advances in pediatric surgery
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• v.3 no.1
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• pp.47-53
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• 1997

Accidental ingestion of caustic substance is one of the common problems among children around the world. Acid intake accounts for a mere 5% of all reported cases of corrosive ingestion in the West. Because of the esophageal sparing effect of acid, clinically significant esophageal involvement after acid ingestion occurs in only 6 to 20 percent of the instances. Despite effort of prevention, 7% to 15% of children sustaining caustic esophageal burns develop esophageal strictures. If balloon dilatation or bougie dilatation fails to resolve the esophageal strictures, successful outcome following replacement by colon or stomach has been reported in children. But the complications and morbidity following these operations are still relatively high. Seven patients with corrosive-acid induced esophageal strictures who were operated upon at the Department of Pediatric Surgery, Seoul National University Children's Hospital from 1991 to 1995 were reviewed. Primary resection and anastomosis was performed in all of 7 patients. The stricture involved short segments of the esophagus at the level of the lower cervical and the upper thoracic vertebra. The operations were approached through a left cervical incision or a left thoracotomy. In one patient, operative repair of anastomotic leakage was done, and three patients required re-resection of anastomotic strictures postoperatively, and one patient required a third operation(reversed gastric tube) due to an anastomotic stricture. The other anastomotic leaks, strictures or pulmonary complications were resolved with conservative treatment. In conclusion, primary resection and anastomosis of the esophagus was performed successfully on the 6 of 7 children with acid induced corrosive esophageal strictures. This approach is physiologic, especially in children who should have a long life expectancy, and recommended for the treatment of short-segment acid induced corrosive esophageal strictures.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.7
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• pp.4399-4402
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• 2013

Objectives: To analyze underlying disease, fatality rate and the major causes of death of in-patients with malignant tumors in Sichuan Cancer Hospital. Methods: Clinical data of in-patients from 2002 to 2012 were retrospectively analyzed. Results: The top 10 tumors (82.0%of the total) of the malignant tumors of the in-patients were lung, cervical, esophagus, breast, colorectal, nasopharynx, liver and gastric cancers, lymphomas and ovarian cancers. The overall fatality rate was 2.7% during these eleven years, 3.4% and 2.0% for male and females, respectively with statistical significance for the difference (${\chi}^2$=164.737, P<0.001). The top 10 death causes were lung cancer, liver cancer, colorectal cancer, esophagus cancer, gastric cancer, lymphoma, breast cancer, pancreatic cancer, ovarian cancer and nasopharynx cancer. In-patients with pancreatic cancer had the highest fatality rate (9.6%). There were different ranks of death causes in different sex groups and age groups. Conclusion: Prevention and control work of cancer should be enhanced not only for cancers with high incidence such as lung cancer, esophageal cancer but also for the cancers which have low incidence but high fatality rate, such as pancreatic cancer and gallbladder cancer, which would help to improve the survival rate and quality of life of cancer patients in the future.

• Journal of Veterinary Clinics
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• v.35 no.1
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• pp.26-29
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• 2018

A 6-month-old, female poodle presented with a three-month history of persistent regurgitation immediately after eating. On physical examination, the patient was emaciated and dehydrated. Thoracic radiography showed ventral displacement of the trachea and increased radiopacity in the mediastinum, cranial to the heart base. A severely dilated esophagus was identified cranial to the heart on esophagram. Computed tomography (CT) revealed the esophagus was filled with gas, fluid and a little of contrast and dilated from caudo-cervical to cranio-thoracic part. The esophageal diameter was markedly decreased at the heart base. In addition, the trachea was displaced to the left-ventral side of the right aortic trunk and an aberrant left subclavian artery originating from the aorta was identified. There was no evidence of abdominal vascular anomaly. Based on diagnostic imaging, persistent right aortic arch (PRAA) with an aberrant left subclavian artery was diagnosed. The patient did not undergo surgery and died at 15 days after diagnosis. This report describes imaging diagnosis, including CT and radiography in a weaned dog with regurgitation due to esophageal obstruction by PRAA. When PRAA is suspected and conventional radiography or contrast study is insufficient for diagnosis, CT may be helpful for diagnosing PRAA.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1110-1115
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• 1998

Esophagectomy has a high morbidity rate, mainly related to pulmonary complications. The respiratory morbidity of open esophagectomy is high, ranging from 6% to 10%. This high morbidity is partially responsible for the 6∼15% mortality rate of esophagectomy. Many techniques of esophagectomy without thoracotomy have been described since the initial report of Orringer and Sloan. Endoscopic microsurgical dissection of the esophagus was clinically introduced in 1989. Endoscopic microsurgical dissection of the esophagus was developed as a minimally invasive procedure that avoids thoracotomy and provides precise vision during the operation in order to reduce mediastinal trauma and to improve the peri- and post-operative situation. A 20 year-old women who accidentally swallowed about 150 cc of glacial acetic acid underwent an esophagectomy using the operating mediastinoscopy, cervical esophagogastric anastomosis, pyloromyotomy, and feeding jejunostomy tube placement for esophageal stricture. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day. Our clinical experience shows that endoscopic microsurgical dissection of esophagus is a safe and feasible method because it offers excellent optical control and enables the surgeon to operate in a minimally invasive manner.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.584-593
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• 1983

Esophageal reconstruction was performed in 344 patients with irreversible stricture of the esophagus resulting from caustic burns at National Medical Center from 1959 to 1982.There were 113 males and 231 females, and ranging from 2.5 to 58 years of age, and mean age was 26.5 years, and 25 cases were less than 10 years old. Caustic materials were 286 [83.2%] alkali and 50[14.5%] acid. The most frequent stricture site was upper thoracic esophagus as 56.7%, and the next was cervical as 31.4%, and lower, 11.9%. The stomach was involved in 10.8% totally, and hypopharyngeal stricture was also noticed in 3.2%, and in 3 cases, hypopharyngeal reconstruction was needed due to extensive scar change. In 329 of total 344 cases, colon interposition was performed without resection of the strictured esophagus except 4 cases which were complicated T-E fistula or perforation, and most of them, about 10-15 cm of terminal ileum with right half of the colon was used as the graft. The left colon with anti-peristalsis was used as graft only in 30 cases. The most common postoperative complication was anastomotic leak as 16.7% of total cases, and it was 12.5% from neck, 3.3% from ileocolostoma and 0.9% from cologastrostoma. Next common complication was neck stenosis [8.8%], aspiration pneumonia [6.4%], and graft necrosis [3.9%] in order. Overall operative mortality was 5.5% [14/329], and main causes of death were graft necrosis, sepsis due to anastomotic leak, gastric bleeding, and intestinal obstruction. Besides of colon interposition, according to shape or level of the stricture, plastic repair or segmental resection and direct anastomosis was done in 9, and 1 of them were complicated stenosis at the anastomotic site. In lower stricture, esophagogastrostomy was done in 10 cases, and 1 case expired due to hepatitis, and anastomotic stenosis was occurred in 2 cases at 1.5 months and 2.4 years later. During follow-up of 298 cases colon interposition from 6 months to 22 years, 82.6% was excellent, and 2.9% was complained of mild discomfort, and 4 cases were dead laterly, but 3 of them were not related to reconstruction.

• Korean Journal of Bronchoesophagology
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• v.11 no.1
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• pp.15-20
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• 2005

Background : It is well-known that esophageal perforation (EP) is difficult in diagnosis and has high mortality rate despite proper management. There are disputes in regarding the reatment in cases of delayed diagnosis although in the early diagnosed cases, operation is recommended without arguments. Methods: From April, 2001 to December, 2004, nine patients who were diagnosed as EP in our hospital were analyzed retrospectively about the causes, the interval between the cause and the treatment, and operation methods. Results: There were 8 male and one female with men age of 49.3 years (range: 25-67 years). The causes of EP included perforations following operations of corvical spine in three cases, spontaneous perforation(Boehaave syndrome) in two cases, foreign bodies in two cases, operation of esophageal diverticulum in one case and blunt trauma bytraffic accident in one case. Mean interval between the first treatments and the causes was 11.6 days (range: 2-30 days). The sites of perforation were upper third of esophagus in three cases, middle third in three cases and lower third in three cases. All except two cervical cases presented as mediastinitis or empyema at the time of diagnosis. Primary repair and irrigation had been performed in 7 cases but five cases out of them required more than two procedures. Conclusions : More than one procedure wasrequired in the treatment of EP because of contaminations and infections which had been spread at the time of initial manifestatios, howeverprimary closure and massive irrigation is the best method in order to preserve esophagus unless the remaining esophagus is extensively damaged.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.418-421
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• 1998

Thoracoscopic esophagectomy can be performed in esophageal diseases to reduce the postoperative complications. Recently, We encountered a case of esophageal cancer and successfully treated it by thoracoscopic esophagectomy with gastric pull-up. A 59-year-old male was presented with swallowing difficulty and an esophagogram, esophagoscopy, and chest CT showed an ulcerating tumor on the lower esophagus. The operation was performed in three stages: mobilization of the esophagus by thoracoscopic surgery, construction of a gastric tube through a laparotomy, and cervical anastomosis between the esophagus and the gastric pull-through. Hoarseness developed postoperatively, and the postoperative esophagogram showed leakage at the esophagogastric anastomotic site. The anastomotic leakage was healed following surgical drainage and the patient was discharged in good health. Hoarseness subsided spontaneously two months after surgery.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.154-162
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• 1999

The laryngopharyngectomy for tumor ablation is the most common indication for pharyngoesophageal reconstruction in our country. Most of these cases are advanced laryngeal cancer that has spread beyond the larynx, pharynx and cervical esophagus. Such patients are obviously unable to breathe, swallow, or speak in the normal manner. The ideal reconstruction would restore normal anatomy, permitting patients to breathe and swallow without aspiration, and would not require a permanent tracheostomy. Reconstruction of the pharyngoesophageal defect traditionally been carried out with tubed local random flap, deltopectoral or musculocutaneous flap. Another approach is the pedicled enteric flap. But microsurgical reconstruction of the pharyngoesophagus, using either the free jejunal or the tubed radial forearm flap, have now become the preferred technique. Among them, we used jejunal free flap in 39 cases, tubed radial forearm free flap in 5 cases, patched radial forearm free flap in 2 cases and pectoralis major myocutaneous island flap in 2 cases from December 1990 to Febrary 1999. In this paper we illustrated that both forearm and jejunal free flap is a usful alternative in reconstruction of hypopharynx and cervical esophagus.