title: Outcome of patients with esophageal perforations: a multicenter study.
abstract: BACKGROUND
  Recent studies have suggested that stent-grafting may improve the treatment outcome of patients with esophageal perforation, but evidence on this is still lacking.
  
  
  METHODS
  Data on 194 patients who underwent conservative (43 patients), endoclip (4 patients) stent-grafting (63 patients) or surgical treatment (84 patients) for esophageal perforation were retrieved from nine medical centers.
  
  
  RESULTS
  In-hospital/30-day mortality was 17.5 %. Three-year survival was 67.1 %. Age, coronary artery disease, and esophageal malignancy were independent predictors of early mortality. Chi squared automatic interaction detection analysis showed that patients without coronary artery disease, without esophageal malignancy and younger than 70 years had the lowest early mortality (4.1 %). Surgery was associated with slightly lower early mortality (conservative 23.3, endoclips 25.0 %, stent-grafting 19.0 %, surgery 13.1 %; p = 0.499). One center reported a series of more than 20 patients treated with stent-grafting which achieved an early mortality of 7.7 % (2/26 patients). Stent-grafting was associated with better survival with salvaged esophagus (conservative 76.7 %, endoclips 75.0 %, stent-grafting 77.8 %, surgery 56.0 %; p = 0.019). Propensity score adjusted analysis showed that stent-grafting achieved similar early mortality (p = 0.946), but significantly higher survival with salvaged esophagus than with surgical treatment (p = 0.001, OR 0.253, 95 % CI 0.110-0.585). Primary surgical repair was associated with somewhat lower early mortality (14.6 vs. 19.0 %; p = 0.561) and better survival with salvaged esophagus (85.4 vs. 77.8 %; p = 0.337) than stent-grafting.
  
  
  CONCLUSIONS
  Esophageal perforation was associated with a rather high mortality rate in this all-comers population. Stent-grafting failed to decrease operative mortality, but it improved survival with salvaged esophagus. The results of one of the centers indicate that increasing experience with this less invasive procedure may possibly improve the outcome of these patients.
authors.affiliation: Department of Surgery, Oulu University Hospital, PL 21, 90029, Oulu, Finland, faustobiancari@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Juha
authors.initials: J
authors.lastname: Saarnio
authors.forename: Ari
authors.initials: A
authors.lastname: Mennander
authors.forename: Linda
authors.initials: L
authors.lastname: Hypén
authors.forename: Paulina
authors.initials: P
authors.lastname: Salminen
authors.forename: Kari
authors.initials: K
authors.lastname: Kuttila
authors.forename: Mikael
authors.initials: M
authors.lastname: Victorzon
authors.forename: Camilla
authors.initials: C
authors.lastname: Böckelman
authors.forename: Enrico
authors.initials: E
authors.lastname: Tarantino
authors.forename: Olivier
authors.initials: O
authors.lastname: Tiffet
authors.forename: Vesa
authors.initials: V
authors.lastname: Koivukangas
authors.forename: Jon Arne
authors.initials: JA
authors.lastname: Søreide
authors.forename: Asgaut
authors.initials: A
authors.lastname: Viste
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonavina
authors.forename: Halla
authors.initials: H
authors.lastname: Vidarsdóttir
authors.forename: Tomas
authors.initials: T
authors.lastname: Gudbjartsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004939:Esophageal Perforation / Q000401:mortality / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult