How Successful is Esophageal Surgery?

//How Successful is Esophageal Surgery?

How Successful is Esophageal Surgery?

A study* investigated the outcome and complications of 63 dogs and 9 cats who underwent surgery for an esophageal lesion at seven US and Canadian veterinary schools.

In dogs, the most common clinical signs observed on presentation included regurgitation (57%), poor appetite (44%), gagging or retching (43%), weight loss (19%), dysphagia (19%) and ptyalism (17%). The median duration of clinical signs was 3 days (range: 1- 1,056 days).

In cats, the most common clinical signs were poor appetite (67%), weight loss (67%), dysphagia (44%), gagging or retching (44%) and regurgitation (44%). The median duration of clinical signs was 20 days (range: 1- 217 days).

Preop thoracic radiographs of 56 dogs revealed a possible foreign body (64%), pleural effusion (20%), pneumothorax (13%) and pneumo-mediastinum (7%).

Preop thoracic radiographs of 8 cats showed a possible foreign body (25%) and pneumo-mediastinum (13%).

At surgery, the most common esophageal lesion identified in dogs was an esophageal foreign body (79%) (see radiograph showing a utility knife blade in the esophagus of a 9 month old Lab, which lead to a pyothorax). An esophageal perforation was noted in 54% of the dogs, a mass in 11% of the dogs, and an esophageal stricture secondary to persistent right aortic arch (PRAA) in 2 dogs.

In cats, esophageal lesions identified in surgery were esophageal stricture (33%), esophageal foreign body (22% – 1 fish hook, 1 bone) or a mass (22%). Histopath identified the “mass” as an abscess, a diverticulum (1/9) and a fistula (1/9).

Intraop complications were seen in 13% of dogs, including bleeding and blood pressure abnormalities. No cats experienced intraop complications.

Immediate postop complications were observed in 37% of dogs. The most common ones were respiratory complications (19%), vomiting and regurgitation (22%) and hyperthermia (13%). In 33% of cats, immediate postop complications were due to aspiration pneumonia and anemia with pronounced hypotension.

Dogs who had partial esophagectomy or partial esophageal R & A were significantly more likely to develop immediate postop complications. In cats, no factor was significantly associated with the development of postop complications.

Of the 63 dogs in this study, 10% died or were euthanized prior to discharge. Negative prognostic factors include the presence of pneumo-mediastinum and preop leukopenia. In cats, none of the factors evaluated were significantly associated with survival to discharge from the hospital.

Delayed postop complications (within 3 months after surgery) were observed in 23% of the dogs and in 1 cat. The most common delayed postop complications in dogs were persistent regurgitation (12%) and esophageal stricture (5%). In the cat, the only delayed postop complication was an esophageal stricture.

Dogs treated for a perforation or an esophageal FB were significantly less likely to develop delayed postop complications.

Conclusion: around 90% of patients (both dogs and cats) were discharged from the hospital. Esophageal surgery was very successful in this study.

* JS Sutton et al. “Perioperative morbidity and outcome of esophageal surgery in dogs and cats: 72 cases (1993–2013).” JAVMA 2016, Vol. 249, p. 787-793.

 

2018-07-04T18:59:00+00:00 January 29th, 2017|news|Comments Off on How Successful is Esophageal Surgery?

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