title: Management of esophageal perforation in 120 consecutive patients: clinical impact of a structured treatment algorithm.
abstract: BACKGROUND
  The therapy of esophageal perforation is still challenging. The aim of this study was to assess the etiology, specific treatment, and outcome of esophageal disruption in order to generate an optimal therapeutic approach to improve patient's outcome.
  
  
  METHODS
  We reviewed the cases of 120 consecutive patients with esophageal perforation treated within 10 years.
  
  
  RESULTS
  Iatrogenic perforation was the most frequent cause of esophageal perforation (58.3 %); Boerhaave's syndrome was detected in 15 cases (6.8 %). Surgery was performed in 66 patients (55 %), 17 (14 %) patients received conservative treatment and 37 (31 %) patients underwent endoscopic stenting after tumorous perforation. Statistically significant impact on mean survival had Boerhaave's syndrome (p = 0.005), initial sepsis (p = 0.002), pleural effusion/empyema (p = 0.001), mediastinitis (p = 0.003), peritonitis (p = 0.001), and redo-surgery (p = 0.000). Overall mortality rate was 11.7 %, in the esophagectomy group 17 % and in the patients with Boerhaave's syndrome 33.3 %.
  
  
  CONCLUSIONS
  An approach considering etiology and extent of perforation, diagnostic delay, and septic status is required to improve patient's outcome. Primary repair is feasible in patients without intrinsic esophageal disease and evidence of sepsis. The greater the diagnostic delay, the more the destruction of the esophageal wall especially in the case of septic esophageal disease, thus the stronger the argument for esophagectomy if anatomically and/or oncologically possible.
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria. jo.lindenmann@medunigraz.at
authors.forename: Joerg
authors.initials: J
authors.lastname: Lindenmann
authors.forename: Veronika
authors.initials: V
authors.lastname: Matzi
authors.forename: Nicole
authors.initials: N
authors.lastname: Neuboeck
authors.forename: Udo
authors.initials: U
authors.lastname: Anegg
authors.forename: Alfred
authors.initials: A
authors.lastname: Maier
authors.forename: Josef
authors.initials: J
authors.lastname: Smolle
authors.forename: Freyja Maria
authors.initials: FM
authors.lastname: Smolle-Juettner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004939:Esophageal Perforation / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D004945:Esophagoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007902:Length of Stay; D008297:Male; D008477:Mediastinal Diseases / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
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