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Long-Term Outcome of Patients with Spontaneous Esophageal Rupture (Boerhaave's Syndrome) Undergoing Esophagectomy As the Definitive Treatment Strategy
Daniel Vallbohmer*1, Jarmo a. Salo2, Arnulf H. HöLscher1, Christian Gutschow1, Wolfgang SchröDer1, Jari V. RäSäNen2, Eero I. Sihvo2
1Surgery, University of Cologne, Cologne, Germany; 2Division of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital, Helsinki, Finland
Background: Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave's syndrome) is seldom reported, especially in patients undergoing esophagectomy. This surgical option is mainly reserved for patients with severe wall necrosis or large esophageal perforation in which a primary repair appears unpromising. As little data are available about this group of patients, this study was conducted to evaluate the long-term outcome of patients with Boerhaave's syndrome undergoing esophagectomy as definitive treatment strategy.Patients and Methods: The study population included 43 patients (33 male, 10 female; median age: 63 years) with Boerhaave's syndrome who underwent esophagectomy at specialized centers of 2 European countries from 1983 to 2009. All study patients had severe wall necrosis or large perforation of the distal esophagus unsuitable for local repair. Results: Twenty patients had esophagectomy with thoracotomy and 23 transhiatally. In most patients (n=38) an initial cervical esophagostoma was performed. Five patients underwent a direct reconstruction with a gastric conduit. The median length of hospital stay was 45 days with a hospital mortality rate of 30% (13/43 patients). Mortality among those 8 patients with a failed attempt of primary closure of the perforation was 63% (n=5). Twenty six patients were discharged with cervical stoma. Of them, 22 (85%) underwent a delayed reconstruction after a median time of 8 months using either a gastric (n=1) or colon conduit (n=21). In 4 (9%) patients the cervical stoma remained because of poor cardiopulmonary conditions (n=1), late death (n=1) or reconstruction is under planning (n=2). With a median follow up of 42 months, 22 (51%) patients are alive with 20 patients on full oral diet.Conclusion: Surgical therapy with esophagectomy achieves in up to 50% a remarkable long term outcome in the group of Boerhaave's syndrome patients known to have the worst prognostic disease status.
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