Evaluation of urgent esophagectomy in esophageal perforation

Aquino, José Luiz Braga de; Camargo, José Gonzaga Teixeira de; Cecchino, Gustavo Nardini; Pereira, Douglas Alexandre Rizzanti; Bento, Caroline Agnelli; Leandro-Merhi, Vânia Aparecida

doi:10.1590/s0102-67202014000400005

Cited by 18 publications

(11 citation statements)

References 23 publications

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“…Therefore, a multidisciplinary approach is important in this manner. [7][8][9] The purpose of the present study was to present a 4-year single-center experience in the management of EP.…”

Section: Introductionmentioning

confidence: 99%

A 4-year single-center experience in management of esophageal perforation

Sarı¹

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Esophageal perforation (EP) is a lethal surgical emergency that needs to be diagnosed and treated immediately. Diagnosis and treatment options for EP are limited due to its lower incidence. There are scoring systems proposed for this purpose; however, they cannot be applied to every patient. The recent trend in the treatment of EP is toward the non-operative approach over the surgical treatment methods. The purpose of the present study was to evaluate our treatment methods and outcomes in patients with EP. METHODS: Thirteen patients with EP treated in our clinic between 2013 and 2017 were retrospectively reviewed. The Pittsburgh Perforation Severity Score (PSS), systemic condition status, and Clavien-Dindo Classification (CDC) score were assessed, and treatment methods were reviewed. Their effects on morbidity and mortality were examined using Fisher's exact test and biserial correlation test. RESULTS: A total of 13 patients (six males and seven females; median age 64 years) were included in the study. Ten patients were managed non-operative, and three were treated surgically. Of the 10 patients, two had additional surgery after non-operative management. The PSS, systemic condition status, CDC score, duration of stay in the hospital, time to diagnosis, presence of hypotension, and being in shock were strongly correlated with mortality (p<0.05). The PSS, CDC score, and stay in the intensive care unit were strongly correlated with morbidity (p<0.05). The comparison between the non-operative and operative groups did not yield a statistically significant difference in mortality and morbidity. CONCLUSION: Even if the scoring systems help to understand the severity of the condition, they are inadequate to determine the treatment option. Early diagnosis and treatment are the most important steps in management. Operative and non-operative treatment options are not superior to each other, but their complementary use will be more beneficial for the patients.

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“…Therefore, a multidisciplinary approach is important in this manner. [7][8][9] The purpose of the present study was to present a 4-year single-center experience in the management of EP.…”

Section: Introductionmentioning

confidence: 99%

A 4-year single-center experience in management of esophageal perforation

Sarı¹

2018

Ulus Travma Acil Cerrahi Derg

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“…Prognostic factors associated with patient and with disease itself are multiple and poorly explored. Knowing these parameters can allow a better stratification of high-risk groups 2 , 3 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors and Survival Analysis in Esophageal Carcinoma

Tustumi

Kimura

Takeda

et al. 2016

ABCD, arq. bras. cir. dig.

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Background: Despite recent advances in diagnosis and treatment, esophageal cancer still has high mortality. Prognostic factors associated with patient and with disease itself are multiple and poorly explored. Aim: Assess prognostic variables in esophageal cancer patients. Methods: Retrospective review of all patients with esophageal cancer in an oncology referral center. They were divided according to histological diagnosis (444 squamous cell carcinoma patients and 105 adenocarcinoma), and their demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival. Results: No difference was noted between squamous cell carcinoma and esophageal adenocarcinoma overall survival curves. Squamous cell carcinoma presented 22.8% survival after five years against 20.2% for adenocarcinoma. When considering only patients treated with curative intent resection, after five years squamous cell carcinoma survival rate was 56.6 and adenocarcinoma, 58%. In patients with squamous cell carcinoma, poor differentiation histology and tumor size were associated with worse oncology stage, but this was not evidenced in adenocarcinoma. Conclusion: Weight loss (kg), BMI variation (kg/m²) and percentage of weight loss are factors that predict worse stage at diagnosis in the squamous cell carcinoma. In adenocarcinoma, these findings were not statistically significant.

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“…Otherwise, gastrostomy and jejunostomy are carried out along with the first proximal esophagostomy and esophagectomy. Reconstruction is carried out with a gastric tube or a colon placement in a substernal position where the natural esophageal support does not exist anymore 6 months or 1 year later (57,58).…”

Section: Resectionmentioning

confidence: 99%

Thoracic perforations—surgical techniques

Eroğlu¹,

Aydın²,

Yılmaz³

2018

Ann. Transl. Med.

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Esophageal perforation may occur spontaneously, iatrogenically or in connection with traumas. Sepsis may develop in connection with mediastinal and pleural exposure in a very short time as a consequence of disintegration of the esophagus. Esophageal perforation is an emergency accompanied with a high level of mortality and morbidity. Rate of mortality for the perforations in the thoracic region is higher than that in the cervical and abdominal regions. Delay in diagnosis and treatment is the most important factor to affect the mortality. A quick and true diagnosis of esophageal perforation is prerequisite for a successful treatment. There is no certain consensus in relation with the optimal treatment of that life-threatening condition. However, in the event that perforation is detected early in a healthy esophagus, then primary repair is recommended. When it is detected late, nonoperative conservative treatment would be appropriate. The rates of mortality for the operations following a period of 24 h after rupture formation are higher than 50%. Esophagectomy is a type of an operation that is to be considered in the event of an end stage benign esophageal disease or of a large esophageal damage that does not allow primary repair. Significant decrease has been observed in the morbidity and mortality of esophageal perforation due to the improvements in the endoscopical techniques today. Minimally invasive techniques, in which drug eluting stents come first, will become an important step for the treatment of esophageal perforations in the forthcoming years.

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Evaluation of urgent esophagectomy in esophageal perforation

Cited by 18 publications

References 23 publications

A 4-year single-center experience in management of esophageal perforation

A 4-year single-center experience in management of esophageal perforation

Prognostic Factors and Survival Analysis in Esophageal Carcinoma

Thoracic perforations—surgical techniques

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