Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta-Analysis of 75 Studies

World Journal of Surgery - Tập 37 - Trang 1051-1059 - 2013
Fausto Biancari1, Vito D’Andrea2, Rosalba Paone1, Carlo Di Marco2, Grazia Savino2, Vesa Koivukangas1, Juha Saarnio1, Ersilia Lucenteforte3
1Department of Surgery, Oulu University Hospital, Oulu, Finland
2Department of Surgical Sciences, University of Rome “La Sapienza”, Rome, Italy
3Department of Preclinical and Clinical Pharmacology “M. Aiazzi Mancini”, University of Florence, Florence, Italy

Tóm tắt

The current prognosis of esophageal perforation and the efficacy of available treatment methods are not well defined. We performed a systematic review of esophageal perforations published from January 2000 to April 2012 and subjected a proportion of the retrieved data to a meta-analysis. Meta-regression was performed to determine predictors of mortality immediately after esophageal perforation. Analysis of 75 studies resulted in a pooled mortality of 11.9 % [95 % confidence interval (CI) 9.7–14.3: 75 studies with 2,971 patients] with a mean hospital stay of 32.9 days (95 % CI 16.9–48.9: 28 studies with 1,233 patients). Cervical perforations had a pooled mortality of 5.9 %, thoracic perforations 10.9 %, and intraabdominal perforations 13.2 %. Mortality after esophageal perforation secondary to foreign bodies was 2.1 %, iatrogenic perforation 13.2 %, and spontaneous perforation 14.8 %. Treatment started within 24 h after the event resulted in a mortality rate of 7.4 % compared with 20.3 % in patients treated later (risk ratio 2.279, 95 % CI 1.632–3.182). Primary repair was associated with a pooled mortality of 9.5 %, esophagectomy 13.8 %, T-tube or any other tube repair 20.0 %, and stent-grafting 7.3 %. Results of recent studies indicate that mortality after esophageal perforation is high despite any definitive surgical or conservative strategy. Stent-grafting is associated with somewhat lower mortality rates, but studies may be biased by patient selection and limited experience.

Tài liệu tham khảo

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