Outcome of esophageal atresia: inborn versus outborn patients

Summary Esophageal atresia (EA) is a rare congenital disease which is usually not of the detected prenatally. Due to the lack of prenatal diagnosis, some newborns with EA are born outside of specialized centers. Nevertheless, centralized care of EA has been proposed, even if a clear volume–outcome association in EA management remains unconfirmed. Furthermore, whether outcomes differ between outborn and inborn patients with EA has not been systematically investigated. Therefore, this single-center, retrospective study aimed to investigate EA management and outcomes with a special focus on inborn versus outborn patients. The following data were extracted from the medical records of infants with EA from 2009 to 2019: EA type, associated anomalies, complications, and long-term outcome. Patients were allocated into inborn and outborn groups. Altogether, 57 patients were included. Five patients were excluded (referral before surgery, loss of data, death before surgery [n = 1], and incorrect diagnosis [diverticulum, n = 1]). Among all patients, the overall survival rate was 96%, with no mortalities among outborn patients. The overall hospitalization period was shorter for outborn patients. The median follow-up durations were 3.8 years and 3.2 years for inborn and outborn patients, respectively. Overall, 15% of patients underwent delayed primary anastomosis (long-gap atresia [n = 4] and other reasons [n = 4]). Early complications included three anastomotic leakages and one post-operative fistula; 28% of patients developed strictures, which required dilatation, and 38% of patients showed relevant gastroesophageal reflux, which required fundoplication, without any differences between the groups. The two groups had comparable low mortality and expected high morbidity with no significant differences in outcome. The outborn group showed nonsignificant trends toward lower morbidity and shorter hospitalization periods, which might be explained by the overall better clinical status.

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Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome

Pediatric Surgery International ◽

10.1007/s00383-012-3142-2 ◽

2012 ◽

Vol 28 (9) ◽

pp. 899-906 ◽

Cited By ~ 43

Author(s):

Florian Friedmacher ◽

Prem Puri

Keyword(s):

Esophageal Atresia ◽

Primary Anastomosis ◽

Meta Analysis ◽

Term Outcome ◽

Long Term Outcome ◽

Long Gap ◽

Long Gap Esophageal Atresia

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Long-term neurodevelopment in children born with esophageal atresia: a systematic review

Diseases of the Esophagus ◽

10.1093/dote/doab054 ◽

2021 ◽

Author(s):

Camille E van Hoorn ◽

Chantal A ten Kate ◽

Andre B Rietman ◽

Leontien C C Toussaint-Duyster ◽

Robert Jan Stolker ◽

...

Keyword(s):

Cognitive Development ◽

Motor Function ◽

Esophageal Atresia ◽

Current Knowledge ◽

Neurodevelopmental Outcome ◽

Cognitive Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

The One

Summary Background Although the survival rate of esophageal atresia (EA) has increased to over 90%, the risk of functional long-term neurodevelopmental deficits is uncertain. Studies on long-term outcomes of children with EA show conflicting results. Therefore, we provide an overview of the current knowledge on the long-term neurodevelopmental outcome of children with EA. Methods We performed a structured literature search in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google scholar on November 8, 2020 with the keywords ‘esophageal atresia’, ‘long-term outcome’, ‘motor development’, ‘cognitive development’, and ‘neurodevelopment’. Results The initial search identified 945 studies, of which 15 were included. Five of these published outcomes of multiple tests or tested at multiple ages. Regarding infants, one of six studies found impaired neurodevelopment at 1 year of age. Regarding preschoolers, two of five studies found impaired neurodevelopment; the one study assessing cognitive development found normal cognitive outcome. Both studies on motor function reported impairment. Regarding school-agers, the one study on neurodevelopmental outcome reported impairment. Cognitive impairment was found in two out of four studies, and motor function was impaired in both studies studying motor function. Conclusions Long-term neurodevelopment of children born with EA has been assessed with various instruments, with contrasting results. Impairments were mostly found in motor function, but also in cognitive performance. Generally, the long-term outcome of these children is reason for concern. Structured, multidisciplinary long-term follow-up programs for children born with EA would allow to timely detect neurodevelopmental impairments and to intervene, if necessary.

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Early and Long Term Outcome in Children with Esophageal Atresia Treated Over the Last 22 Years

Klinische Pädiatrie ◽

10.1055/s-0030-1249610 ◽

2010 ◽

Vol 222 (05) ◽

pp. 296-301 ◽

Cited By ~ 40

Author(s):

M. Lacher ◽

S. Froehlich ◽

D. von Schweinitz ◽

H. G. Dietz

Keyword(s):

Esophageal Atresia ◽

Term Outcome ◽

Long Term Outcome

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Publication Trends and Global Collaborations on Esophageal Atresia Research: A Bibliometric Study

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1702223 ◽

2020 ◽

Author(s):

Xiaoyan Feng ◽

Illya Martynov ◽

Anne Suttkus ◽

Martin Lacher ◽

Steffi Mayer

Keyword(s):

Esophageal Atresia ◽

Pediatric Surgery ◽

Perioperative Complications ◽

Citation Rate ◽

Surgical Techniques ◽

Global Network ◽

Term Outcome ◽

Long Term Outcome ◽

The Past

Abstract Introduction Research on esophageal atresia (EA) has been heavily published over the past decades. Herein, we aimed to study the quantity and quality as well as key topics in EA research with regards to global collaborations among countries and authors. Material and Methods Publications on EA from 1945 to 2018 were extracted from the Web of Science core collection database. Productivity (quantity) was assessed by the number of publications. Quality was estimated from the number of citations, citation rate per item and year, h-index, and impact index. Collaborative networks were evaluated using VOSviewer. All measures were analyzed for countries, authors, and journals. The 10 most cited original articles between 1969 and 2018 in 5-year intervals (n = 100) were manually screened to assess the key points of EA research. Results A total of 2,170 publications from 85 countries published in 388 journals were identified yielding 26,755 citations, both significantly increasing over time (p < 0.001). The most productive countries and authors also accounted for high-quality publications and benefited from an active global network. The most productive journals derived from the field of pediatric surgery but accounted only for one-third of EA papers. The best cited journals were unspecific for pediatric surgery. Long-term outcome remained the most important topic in EA research, followed by surgical techniques, epidemiology, associated anomalies, perioperative complications, and postnatal management. In contrast, basic science was underrepresented. Conclusion Over the past seven decades, EA publications increased tremendously. Productiveness and quality benefited from global networking. Long-term outcome remains the key interest of EA research.

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The Long-term Outcome of Esophageal Atresia

Journal of the Korean Association of Pediatric Surgeons ◽

10.13029/jkaps.2008.14.2.117 ◽

2008 ◽

Vol 14 (2) ◽

pp. 117 ◽

Cited By ~ 2

Author(s):

Jae Hong Jeong ◽

Hye Eun Kim ◽

Suk Koo Lee ◽

Jeong Meen Seo

Keyword(s):

Esophageal Atresia ◽

Term Outcome ◽

Long Term Outcome

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The Galway Study of Panic Disorder III

The British Journal of Psychiatry ◽

10.1192/bjp.168.4.462 ◽

1996 ◽

Vol 168 (4) ◽

pp. 462-469 ◽

Cited By ~ 31

Author(s):

D. O'rourke ◽

T. J. Fahy ◽

J. Brophy ◽

P. Prescott

Keyword(s):

Panic Disorder ◽

Controlled Trial ◽

Clinical Status ◽

Complete Recovery ◽

Acute Stage ◽

Severe Illness ◽

Term Outcome ◽

Long Term Outcome ◽

Research Interview

BackgroundThe aim was to evaluate long-term outcome of DSM–III–R panic disorder at a mean of 5.3 years following a controlled trial of treatment that included antidepressants and behavioural counselling.MethodSixty-eight (86%) subjects were evaluated by lengthy research interview.ResultsThirty-four per cent recovered and remained well, 46% were minimally impaired and 20% had persistent panic disorder of whom half remained significantly impaired. Anxious–fearful personality dysfunction was the most important predictor of poor outcome, followed by poor clinical status at discharge and inability at baseline to recall vividly the initial panic attack. Those who dropped out from the original trial did badly.ConclusionsComplete recovery can occur even after many years of severe illness in a large minority of subjects who receive both antidepressants and behavioural counselling in the acute stage of treatment. The comparative prognostic value of personality, severity and chronicity need to be more fully addressed in future studies.

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Outcomes following resection of intramedullary spinal cord cavernous malformations: a 25-year experience

Journal of Neurosurgery Spine ◽

10.3171/2011.1.spine10454 ◽

2011 ◽

Vol 14 (5) ◽

pp. 605-611 ◽

Cited By ~ 28

Author(s):

Alim P. Mitha ◽

Jay D. Turner ◽

Adib A. Abla ◽

A. Giancarlo Vishteh ◽

Robert F. Spetzler

Keyword(s):

Spinal Cord ◽

Clinical Status ◽

Term Outcome ◽

Intramedullary Spinal Cord ◽

Cavernous Malformations ◽

Long Term Outcome ◽

Single Center Experience ◽

Csf Leakage ◽

Preoperative Status

Object The management of intramedullary spinal cord cavernous malformations (CMs) is controversial. At Barrow Neurological Institute, the authors selectively offer surgical treatment for symptomatic spinal cord CMs. The purpose of this paper is to review the clinical outcomes in patients after resection of these lesions based on a single-center experience over a 25-year period. Methods The records of 80 patients who underwent resection of pathologically confirmed spinal cord CMs from January 1985 to May 2010 were analyzed retrospectively. Preoperative clinical status and imaging findings were evaluated as well as immediate and long-term postoperative outcomes. Results Compared with their preoperative Frankel grade, 11% of patients were worse, 83% were the same, and 6% improved immediately after surgery. At a mean follow-up interval of 5 years, 10% of patients were worse, 68% were the same, and 23% were improved compared with their preoperative status. Five percent of patients underwent reoperation for resection of a symptomatic residual or recurrent lesion. Immediate complications were encountered in 6% of patients, including CSF leakage and deep venous thrombosis. Long-term complications were encountered in 14% of patients and included kyphotic deformity, stenosis, and spinal cord tethering. A significant correlation was found between long-term outcome and anteroposterior length of the lesion (p = 0.01). Conclusions The resection of intramedullary spinal cord CMs can be achieved with good long-term outcomes and an acceptable risk of immediate or delayed complications.

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Immediate and long-term outcome in operated esophageal atresia

Pediatru ro ◽

10.26416/pedi.50.2.2018.1774 ◽

2018 ◽

Vol 2 (50) ◽

pp. 28

Author(s):

G.I. Criscov ◽

O.I. Bărbuţă ◽

Elena Ţarcă ◽

Bogdan A. Stana

Keyword(s):

Esophageal Atresia ◽

Term Outcome ◽

Long Term Outcome

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Esophageal resection in Austria—preparing a national registry

European Surgery ◽

10.1007/s10353-021-00734-8 ◽

2021 ◽

Author(s):

Matthias Paireder ◽

Reza Asari ◽

Wolfgang Radlspöck ◽

Anna Fabbri ◽

Andreas Tschoner ◽

...

Keyword(s):

Improve Patient Safety ◽

High Volume ◽

Esophageal Resection ◽

National Registry ◽

Outcome Data ◽

Esophageal Surgery ◽

High Morbidity ◽

Term Outcome ◽

Long Term Outcome ◽

Invasive Approach

Summary Background Esophageal resection is a technically challenging procedure. Despite improvements in perioperative management and outcome, it is still associated with considerably high morbidity and mortality rates even if performed in high-volume centers. This study aimed to shed light on the results of routine patient care in three representative referral centers concerning caseload and surgical and oncological outcomes. Methods This study is a retrospective, multicenter, national-wide analysis of a newly established database including perioperative and long-term outcome data from three referral centers in Austria. Results In a 6-year study period (2013–2018), 411 patients were eligible for analysis. The indication for esophageal resection was esophageal adenocarcinoma in 299 (72.7%) patients and esophageal squamous cell carcinoma in 90 (21.9%) patients. The abdominothoracic approach (70.1%) was the most common operation, followed by transhiatal extended gastrectomy (14.8%) and a thoracic-abdominal-cervical approach (8.5%). Most patients (77.9%) underwent neoadjuvant therapy (chemotherapy 45.3%, radiochemotherapy in 32.6%). A minimally invasive approach was chosen in 25.3%. Major complications and mortality were seen in 21.7% and 2.9%, respectively. The 1‑year survival rate was 84%, 3‑year survival 60%, and 5‑year survival was 52%. The pooled overall median survival was 110 months (95% CI 33.97–186.03). Conclusion This first publication of the Austrian Society of Esophageal Surgery shows that the outcome of esophageal surgery for cancer in Austria compares well with that of renowned international centers. However, a more comprehensive approach including as many national centers as possible will improve outcome research, offer quality management, and improve patient safety. The study group invites all Austrian institutions performing esophagectomy to participate in the initiative.

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