Evaluation of the Prognosis in Esophageal Atresia

(1)

1

Vol. 7, No. l. June 2001

Evaluation of the Prognosis in Esophageal Atresia

Hyun-Hahk Kim, M.D., Hyeon A Jeong, M.D.,

Kyung-Hun Kim, M.D. and Jung Han Kim, M.D., Suk-Koo Lee, M.D.

Division of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

The aims of this study were to evaluate the prognostic predictabilities of the risk classi- fications (Waterston, Montreal, and Spitz), preoperative treatment of pneumonia and the length of esophageal gap in esophageal atresia. Twenty-five cases of esophageal atresia were reviewed retrospectively. The data was analyzed with Likelihood ratio test for trend and Fisher's exact test. Survival rates were 100.0 % in group A and B, and 60.0 % in group C according to Waters ton classification (p=0.027). By Montreal classification, 95.7 % in group I and 50.0 % in group II (p=0.086)' By Spitz classification, 95.5 % in group I and 66.7% in group II (p=0.159). The survival rate was 85.7 % in the patients with pneumonia preoperatively treated and 94.4 % in the patients without pneumonia. The difference was not significant (p=0.490). Survival rate in the patients with long gap (:2 3cm) was 50.0 % and 100.0 % in patients with short gap « 3cm) with significant difference (p=0.020)' The Waterston classification could be modified into two groups because the prognosis of both group A and B were the same. Preoperative pneumonia does not seem to be a risk factor. The length of the esophageal gap showed prognostic value. (J Kor Assoc Pecliatr Surg 7(1) 1-6, 200l)

Index Words: Esopmgeal atresia, Tracheoesopmgeal fistula, Prognosis

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Table 2. Waterston Classification

Group Criteria

A Birth weight 2,500 g

No pneumonia, no anomalies B Birth weight 1,800-2,500 g

No pneumonia, no anomalies or

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Table 1. Associated Anomalies Anomaly

Congenital heart disease Skeletal

Face

Gastrointestinal Single umbilical artery Genitourinary

Cases Deaths

6 0

14 0

5 2

No (%) 11(44.0)

6(24.0) 5(20.0) 4(16.0) 3(12.0) 2( 8.0)

Survival (%) 100.0

100.0

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(3)

Table 3. Montreal Classification

Group Criteria

No ventilator dependence None, minor or major anomalies

or

Ventilator dependent None or minor anomalies II Ventilator dependent

Major anomalies or

No ventilator dependence Life-threatening anomalies P == 0.086

Table 4. Spitz Classification

Group Criteria

I Birth weight ~ 1 ,500 g without Major congenital heart disease II Birth weight < 1 ,500 g or

Major congenital heart disease III Birth weight < 1 ,500 g and

Major congenital heart disease p == 0.159

Table 5. Preoperatively Treated Pneumonia and Survival Pneumonia Cases Death Survival (%)

Yes and treated 7 85.7

No 18 94.4

p == 0.490

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Table 6. Length of the Esophageal Gap and Survival Gap length Cases Death Survival (%)

Long (~3cm) 4 2 50.0

Short «3cm) 21 0 100.0

p == 0.020

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1. Michiaki Y, Heidrun G, Bernd R, Dieter B: Esophageal atresia in Bremen, Germany-evaluation of preoperative risk classification in esophageal atresia. J Pediatr Surg 35:584- 587, 2000

2. Waterston DJ, Bonham Carter RE, Aberdeen E: Oeso- phageal atresia: tracheo-oesophageal fistula. A study of survival in 218 infants. Lancet 1:819-822, 1962

3. Choudhury SR, Keith WA, Ronald JS, Murphy JP, Charles LS, David LS: Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg 34:70-74, 1999

4. Saing H, George H, Cheng W: The involvement of two or more systems and the severity of associated anom- alies significantly influence mortality in esophageal atr- esia. J Pediatr Surg 33:1596-1598, 1998

5. Steven T, Daniel PB, Margaret EG, Denis RK: Prog- nostic classification for esophageal atresia and tracheo- esophageal fistula: Waterston versus Montreal. J Pediatr Surg 32:1075-1080, 1997

6. Spitz L, Kiely EM, Morecroft JA, Drake DP: Oeso- phageal atresia: at risk groups for the 1990s. J Pediatr

Surg 29:723-725, 1994

7. Poenaru DP, Laberge JM, Neison IR, Guttman FM: A new prognostic classification for esophageal atresia.

Surgery 113:426-432, 1993

8. Sigmund HE, Barry S, David W, Robert MF: Esopha- geal atresia with distal tracheoesophageal fistula:

associated anomalies and prognosis in the 1980s. J Pediatr Surg 24:1055-1059, 1989

9. Randolph JG, Newman KD, Anderson KD: Current results in repair of esophageal atresia with tracheo- esophageal fistula using physiologic status as a guide to therapy. Ann Surg 209:526-531, 1989

10. Spitz L, Kiely E, Brereton RJ: Esophageal atresia: five year experience with 148 cases. J Pediatr Surg 22:103-108,

1987

11. Linda JH, Dudley NE: A comparison between gap- length and Waterston classification as guides to mor- tality and morbidity after surgery for esophageal atresia. J Pediatr Surg 21 :404-406, 1986

12. Louhimo I, Lindahl H: Esophageal atresia: primary results of 500 consecutively treated patients. J Pediatr Surg 18:217- 229, 1983

13. Weber TR, Smith W, Grosfeld JL: Surgical experience in infants with the VATER association. J Pediatr Surg 15:849- 854, 1980

(6)

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18. Dunn le, Fonkalsrud EW,Atkinson 1B: Simplifying the Waterston's stratification of infants with tracheoesopha- geal fistula. Am Surg 65:908-910, 1999

19. Mee RBB, Beasley SW, Au1dist AW, Myers NA: Influ- ence of congenital heart disease on management of oeso- phageal atresia. Pediatr Surg Int 7:90-93, 1992