title: Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies.
abstract: OBJECTIVE
  To evaluate the efficacy of surgical treatment for esophageal perforation.
  
  
  METHODS
  A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series.
  
  
  RESULTS
  Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05).
  
  
  CONCLUSIONS
  Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.
authors.affiliation: Postgraduate Program in General Basis of Surgery, Botucatu School of Medicine, UNESP, Brazil.
authors.forename: Claudia Nishida
authors.initials: CN
authors.lastname: Hasimoto
authors.forename: Cristina
authors.initials: C
authors.lastname: Cataneo
authors.forename: Regina
authors.initials: R
authors.lastname: Eldib
authors.forename: Rafael
authors.initials: R
authors.lastname: Thomazi
authors.forename: Rodrigo Severo de Camargo
authors.initials: RS
authors.lastname: Pereira
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Minossi
authors.forename: Antonio José Maria
authors.initials: AJ
authors.lastname: Cataneo
mesh_terms: D016009:Chi-Square Distribution; D004939:Esophageal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome