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Lessons From a Quarter of Century Treating Esophageal Perforations: a Proposal of a Decision-Making Algorithm
Marisa Aral*, Hugo Santos-Sousa, José Costa-Maia
General Surgery Department, Centro Hospitalar de São João, University of Porto Medical School, Porto, Portugal
Introduction: Esophageal perforation (EP) is a rare diagnosis, with a high morbidity and mortality, and its therapy is still challenging. The aim of this study was to assess the etiology, specific treatment and outcome of EP in order to generate an optimal therapeutic approach to improve patient's outcome.
Methods: Analysis of a prospective database with cases of EP (n=71) treated in an Upper GI Surgery Unit, between January 1991 and October 2014.
Results: The majority of EP were traumatic (60,6%) and thoracic (62%). The median timing of diagnosis was 24 [1-336] hours. The severity score median was 4 [0-14]. Non-operative treatment was done in 22,5%. Primary repair was the most common option (52,7%) in operative treatment. The median LOS was 26 [4-266] days. The morbidity and mortality rates were 40,8% and 15,5%. Morbidity was significantly associated to etiology (p=0,003), type of management (p=0,001) and severity score (p<0,001) [presence at presentation of tachycardia (p=0,001), pleural effusion (p<0,001), non-contained leak (p<0,001), respiratory compromise (p<0,001) and hypotension (p=0,012)]. Mortality was significantly associated to etiology (p=0,02), esophageal pathology (p=0,002), location (p=0,004) and severity score (p=0,009) [age (0,016), presence at presentation of tachycardia (p=0,002), hypotension (p=0,006) and cancer (p=0,07)]. The timing of diagnosis didn't significantly influence morbidity or mortality.
Conclusions: Based in the results of this study we propose a decision-making algorithm to best assist in the choice of EP treatment in each patient.
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