Iatrogenic perforation of cancer of the esophagus or the gastroesophageal (GE) junction is a severe complication. Its incidence has increased most likely because of more aggressive palliative endoscopic therapy and the current widespread use of endoscopic ultrasound (EUS) for accurate preoperative staging. Therapy, i.e. conservative versus surgical treatment remains controversial.
In a June 28 World Journal of Gastroenterology paper, Technical University of Munich professor Jörg Kleeff reported the case of an 82-year-old man with iatrogenic perforation of adenocarcinoma of the GE junction.
Given serious complications brought on by initial endoscopic intervention, the doctors chose immediate explorative laparotomy. Intraoperatively, the tumor was localized and removed completely by resection of the cardia and part of the distal esophagus. For reconstruction, a partial proximal gastric tube was constructed using linear staplers. After treatment, the patient recovered quickly and was discharged from hospital within 2 wk. On a further follow-up after 4 wk, the patient held no complaint of reflux or dysphagic symptoms.
The study revealed that the management of esophageal perforation in the context of an underlying malignancy demands an individual approach that depends upon the site and etiology of the perforation. Irrespective of the therapeutic approach, the prognosis after tumor perforation is dismal.