title: Thoracic esophageal perforations.
abstract: BACKGROUND
  Recognition of the importance of early diagnosis and aggressive, definitive surgical intervention has brought about a dramatic decline in mortality related to distal esophageal perforation.
  
  
  METHODS
  We retrospectively analyzed all cases of thoracic esophageal perforation diagnosed at our hospital from September 1, 1979, through April 1, 2001. The study group consisted of 62 patients (43 men) with a mean age of 58.8 years (range, 20-92 yr).
  
  
  RESULTS
  In the group of 39 patients with early diagnosis (< or = 24 h), hospital survival was 87%, which increased to 93% when early diagnosis was combined with aggressive surgical treatment Among the 23 patients with late diagnosis (> 24 h), survival approached 70%. Yet, in patients who were treated aggressively with surgery, survival was almost 90% despite delayed diagnosis.
  
  
  CONCLUSIONS
  We recommend aggressive, definitive surgery for thoracic esophageal perforations, whether diagnosed early or late. A variety of options are discussed with regard to complicated presentations.
authors.affiliation: Section of Thoracic and Cardiovascular Surgery, Department of Medicine, Inova Fairfax Hospital, Inova Health System, Annandale, VA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Kiernan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sheridan
authors.forename: Eric
authors.initials: E
authors.lastname: Elster
authors.forename: John
authors.initials: J
authors.lastname: Rhee
authors.forename: Lucas
authors.initials: L
authors.lastname: Collazo
authors.forename: William D
authors.initials: WD
authors.lastname: Byrne
authors.forename: Thomas
authors.initials: T
authors.lastname: Fulcher
authors.forename: Vivian
authors.initials: V
authors.lastname: Hettrick
authors.forename: Betty
authors.initials: B
authors.lastname: Vaughan
authors.forename: Paula
authors.initials: P
authors.lastname: Graling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004939:Esophageal Perforation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors