Randomized trial comparing esophageal resection versus substitution alone for corrosive esophageal strictures
In brief
Pulmonary complications occur in about 10% after both resection and substitution alone
In a randomized trial of 143 patients with refractory corrosive esophageal strictures, postoperative pulmonary complications developed in 11.6% of those undergoing esophageal resection and 8.1% of those receiving substitution alone, a difference that did not meet non-inferiority criteria. Operative time was longer for resection, but overall morbidity, mortality and 12-month quality-of-life scores were similar, leaving the choice of technique still dependent on surgeon expertise and patient factors.
- Journal
- Esophagus : official journal of the Japan Esophageal Society (Q1)
- Published
- 20 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Nihar Ranjan Dash, Lokesh Agarwal, Sujoy Pal, Alok Thakar, Chirom Amit Singh, Kumble Seetharama Madhusudhan, et al.
- PMID
- 42763383
- DOI
- 10.1007/s10388-026-01254-8
Why clinicians should know about it
- Picked for Surgery (paper of the day, 21 September 2026): RCT esophagectomy vs substitution for corrosive strictures
Abstract
OBJECTIVE: To compare perioperative safety and long-term functional outcomes of esophageal resection versus substitution-alone in patients with corrosive esophageal strictures refractory to endoscopic dilatation. METHODS: This prospective, single-center, open-label, parallel-group, non-inferiority randomized controlled trial was conducted at a tertiary referral center in India. Patients aged 14-60 years with corrosive esophageal strictures unresponsive to serial dilatation were included. Participants were randomized in a 1:1 ratio to either esophageal resection or substitution-alone group. The primary outcome was incidence of postoperative pulmonary complications (PPC) within 30 days. Secondary outcomes included operative parameters, postoperative morbidity, mortality, and health-related quality-of-life (HRQOL) assessed using the Gastrointestinal-Quality-of-Life-Index (GIQLI). RESULTS: Between September 2012 and December 2023, 143 patients were randomized (resection, n=69; substitution-alone, n=74), and all were analyzed. PPC occurred in 11.6% of the resection group and 8.1% of the substitution-alone group (absolute risk difference, 3.5%; 95% CI -6.3% to 13.3%); the prespecified non-inferiority criterion was not met. Mediastinal dissection time was significantly longer in the resection group (48 ± 28 vs 22 ± 8 min; p < 0.001). However, total operative duration, blood loss, cervical anastomotic leak rates, recurrent laryngeal nerve palsy, and length of hospital stay were comparable between groups. One mortality (0.7%) occurred in the resection group due to a colo-colic anastomotic leak. At 12-months, mean GIQLI scores were higher following resection (118.6 ± 11.2 vs. 111.2 ± 12.8; p=0.08). CONCLUSIONS: Esophageal resection and substitution-alone were associated with comparable perioperative outcomes in patients with corrosive esophageal strictures. Although formal non-inferiority of esophageal resection was not established, no significant difference in PPC was observed. The higher HRQOL scores following resection should be considered exploratory. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2015/10/006237).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.