title: Emergent Esophagectomy for Esophageal Perforations: A Safe Option.
abstract: BACKGROUND
  Esophageal perforation is an injury associated with high morbidity and mortality. Initial management ranges from observation to esophagectomy. The aim of this study was to evaluate the relative mortality and safety of emergent esophagectomy for acute esophageal rupture when compared with elective esophagectomies.
  
  
  METHODS
  We performed a retrospective review of a prospective esophagectomy database from a single institution from 1977 to 2013. Patients who were admitted for esophageal perforation and underwent esophagectomy were identified and compared with patients who underwent elective esophagectomy.
  
  
  RESULTS
  In all, 3,015 patients received an esophagectomy in elective and emergent settings; 90 esophagectomies were for acute injuries (52 for benign and 38 for malignant causes). A longer median length of stay was associated with emergent esophagectomy compared with elective esophagectomy (13 versus 10 days, p < 0.0001), and the complication rates were higher in the emergent group (51.1% versus 35.6%, p = 0.003). The survival rates at 30 days, 1 year, and 5 years after surgery were not significantly different between the emergent and nonemergent esophagectomy groups for patients with both benign and malignant underlying conditions. Within the emergent group, there was no difference in 30-day or 6-month survival based on benign or malignant causes, but a significant difference was seen at 1 year (85% for benign versus 65% for malignant, p = 0.025) and 5 years for survival (72% versus 21%, p < 0.001).
  
  
  CONCLUSIONS
  Emergent esophagectomy represents a safe option for the treatment of esophageal perforation, with mortality comparable to elective esophagectomy.
authors.affiliation: University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Y David
authors.initials: YD
authors.lastname: Seo
authors.affiliation: Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Jules
authors.initials: J
authors.lastname: Lin
authors.affiliation: Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Chang
authors.affiliation: Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Orringer
authors.affiliation: Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: William R
authors.initials: WR
authors.lastname: Lynch
authors.affiliation: Section of General Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan. Electronic address: reddyrm@med.umich.edu.
authors.forename: Rishindra M
authors.initials: RM
authors.lastname: Reddy
mesh_terms: D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D004939:Esophageal Perforation / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies