To the Editor.—We found the article by Yeo and colleagues1 in the August Archives to be extremely interesting. Esophageal perforation is a catastrophic event and requires emergent surgical therapy.2 When the underlying cause is a malignant esophageal obstruction, the prognosis is poor, and the authors are to be commended for their exemplary results.
When confronted with a promptly recognized perforation in a patient with esophageal carcinoma, if the patient is a good operable candidate and the lesion is otherwise believed to be resectable, we agree that resection of the entire thoracic esophagus, including the perforation and tumor, with an immediate esophagogastrostomy may be far safer and more satisfactory than relying on repair and drainage.2 Unfortunately, these patients usually suffer from multiple difficulties, including substantial nutritional problems and recurrent aspiration pneumonia. The surgeon is then required to undertake a major procedure in a debilitated patient without benefit
WETSTEIN L, KIRBY DF. Esophageal Perforation. Arch Surg. 1989;124(7):876. doi:10.1001/archsurg.1989.01410070136030