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Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies.

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies.
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Law TT, Chan JY, Chan DK, Tong D, Wong IY, Chan FS, Law S,


Law TT, Chan JY, Chan DK, Tong D, Wong IY, Chan FS, Law S, (click to view)

Law TT, Chan JY, Chan DK, Tong D, Wong IY, Chan FS, Law S,

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Hong Kong medical journal = Xianggang yi xue za zhi 2017 03 10() doi 10.12809/hkmj164942
Abstract
INTRODUCTION
The mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality.

METHODS
We retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed.

RESULTS
We identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaave’s syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with in-hospital mortality (P=0.03, <0.01, and <0.01, respectively). CONCLUSIONS
Most oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.

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