Faculty Collaboration Database

The management of treatment-related esophageal complications in children and adolescents with cancer. J Pediatr Surg 2006 Mar;41(3):495-9

Date

03/07/2006

Pubmed ID

16516623

DOI

10.1016/j.jpedsurg.2005.11.065

Scopus ID

2-s2.0-33644686779 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

BACKGROUND AND PURPOSE: Serious treatment-induced esophageal strictures and tracheoesophageal fistulae are rare in the pediatric oncology population. This report details our experience with their management.

METHODS: We retrospectively reviewed our experience with pediatric oncology patients treated for esophageal complications over a 23-year period. Serious complications were defined as development of strictures requiring dilatation or an esophageal fistula. Fifteen patients were identified, 5 of which had been previously reported.

RESULTS: Thirteen patients developed esophageal stricture, and 2 progressed to tracheoesophageal fistulae. The remaining 2 patients developed tracheoesophageal fistulae without antecedent stricture. The median interval from cancer diagnosis until development of esophageal complications was 3.5 years (range, 0.4-11.8 years). Before development of esophageal complication, 14 patients (93%) were treated with mediastinal radiation and 7 (47%) for candidal esophagitis. Strictures were most commonly located in the distal esophagus (5), then midesophagus (3), cervical esophagus (3) and diffusely (2). A median of 5 dilatations (range, 1-50) were necessary before patients were able to resume a normal diet. The origin of tracheoesophageal fistulae was the midesophagus (3) and distal esophagus (1). All 4 patients with fistulae were treated with esophageal division and diversion followed by esophagocoloplasty.

CONCLUSIONS: Esophageal strictures and fistulae may occur because of cancer therapy in childhood. Prevention includes early treatment of esophagitis especially Candida mucositis, and minimization of radiation dose to the esophagus. Strictures usually respond to dilatation, but fistulae require esophageal diversion and secondary reconstruction.

Author List

Lal DR, Foroutan HR, Su WT, Wolden SL, Boulad F, La Quaglia MP

Author

Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Candidiasis
Child
Child, Preschool
Esophageal Stenosis
Esophagitis
Female
Humans
Male
Radiation Injuries
Retrospective Studies
Tracheoesophageal Fistula
Treatment Outcome