title: [Esophageal perforation: which factors affect the prognosis? Results of a 10-year experience].
abstract: Oesophageal perforations are a catastrophic event with a 10-40% mortality rate. The decisive prognostic factor is the time from the event to the diagnosis, while there is no agreement as to the therapeutic options. The aim of this study was to present our ten-year experience in the treatment of oesophageal perforations together with an evaluation of the prognostic factors. From January 1995 to January 2005, 18 patients (11 M, 7 F), mean age 49.3 years (range: 22-79), with oesophageal perforations were treated in our department. They were classified according to the cause and localization of the perforation and the time elapsing since the event. The perforation was localised in the cervical oesophagus in 4 patients (22.2%), in the abdominal oesophagus in 4 patients (22.2%) and in the thoracic oesophagus in 10 patients (55.5%). It was spontaneous in 4 patients (22.2%), traumatic in 4 (22.2%) and iatrogenic in the remaining 10 (55.5%). In 7 patients (38.9%), the treatment was started during the first 24 hours from the event, while the remaining 11 (61.1 %) were referred to us more than 24 hours after the perforation occurred. The overall mortality was 27.8% (5 patients). The only decisive prognostic factor was the time of observation: only 1 patient (14.3%) died in the group observed in the first 24 hours, while the remaining 4 who died (36.4%) were in the group treated more than 24 hours after the event (p < 0.05). Our series confirms that the time elapsing from the event to the diagnosis is the only decisive prognostic factor in the treatment of oesophageal perforations. There is no therapeutic option of choice since there is no significant influence of either cause or localisation of the perforation on outcome.
authors.affiliation: I Divisione di Chirurgia Generale e Gastroenterologica Seconda Università degli Studi di Napoli.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Maffettone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Napolitano
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.forename: Gianmattia
authors.initials: G
authors.lastname: del Genio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Russo
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Pizza
authors.forename: Maria
authors.initials: M
authors.lastname: Di Martino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.forename: Alberto
authors.initials: A
authors.lastname: del Genio
mesh_terms: D000328:Adult; D000368:Aged; D004939:Esophageal Perforation / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis