title: Treatment of esophageal perforation in octogenarians: a multicenter study.
abstract: Esophageal perforation is associated with significant mortality, and this may markedly increase with advanced age. This multicenter study investigates this issue in patients older than 80 years. Data on 33 patients >80 years old who underwent conservative (10 patients), endoclip (one patient), stent grafting (11 patients), or surgical treatment (11 patients) for esophageal perforation were collected from nine centers. Surgical repair consisted of repair on drain in one patient, primary repair in seven patients, and esophagectomy in two patients. Among patients who underwent stent grafting, one required repeat stenting and another stent graft repositioning. One patient was converted to surgical repair after stent grafting. Thirteen patients (39.4%) died during the 30-day and/or in-hospital stay. Their mortality was significantly higher than in a series of patients<80 years old (13.0%, 21/161 patients, P=0.001). Three patients (30.0%) died after conservative treatment, one (100%) after treatment with endoclips, five (45.5%) after stent grafting, and four (36.4%) after surgical repair (P=0.548). Early survival with salvaged esophagus was 42.4% (conservative treatment: 70.0% endoclips 0%, stent grafting: 54.5%, and surgical repair: 54.5%, respectively, P=0.558). Estimated glomerular filtration rate<60 mL/minute/1.73 m2 (70.0% vs. 25.0%, P=0.043) and sepsis (100% vs. 32.1%, P=0.049) at presentation were associated with increased risk of early mortality in univariate analysis. Esophageal perforation in octogenarians is associated with very high early and intermediate high mortality irrespective of the treatment method used.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.forename: T
authors.initials: T
authors.lastname: Gudbjartsson
authors.forename: A
authors.initials: A
authors.lastname: Mennander
authors.forename: L
authors.initials: L
authors.lastname: Hypén
authors.forename: P
authors.initials: P
authors.lastname: Salminen
authors.forename: K
authors.initials: K
authors.lastname: Kuttila
authors.forename: M
authors.initials: M
authors.lastname: Viktorzon
authors.forename: C
authors.initials: C
authors.lastname: Böckelman
authors.forename: E
authors.initials: E
authors.lastname: Tarantino
authors.forename: O
authors.initials: O
authors.lastname: Tiffet
authors.forename: V
authors.initials: V
authors.lastname: Koivukangas
authors.forename: J A
authors.initials: JA
authors.lastname: Søreide
authors.forename: A
authors.initials: A
authors.lastname: Viste
authors.forename: L
authors.initials: L
authors.lastname: Bonavina
authors.forename: H H
authors.initials: HH
authors.lastname: Vidarsdottir
authors.forename: J
authors.initials: J
authors.lastname: Saarnio
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D004939:Esophageal Perforation / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: esophageal perforation; esophageal rupture; esophagectomy; esophagus; octogenarian; stent-graft