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Article: Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies
Title | Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies |
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Authors | |
Issue Date | 2017 |
Publisher | Hong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/ |
Citation | Hong Kong Medical Journal, 2017, v. 23 n. 3, p. 231-238 How to Cite? |
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 after oesophageal perforation treatment. 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 Boerhaaveâ 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 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. |
Persistent Identifier | http://hdl.handle.net/10722/242272 |
ISSN | 2023 Impact Factor: 3.1 2023 SCImago Journal Rankings: 0.261 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Law, TT | - |
dc.contributor.author | Chan, JYL | - |
dc.contributor.author | Chan, KKD | - |
dc.contributor.author | Tong, DKH | - |
dc.contributor.author | Wong, YHI | - |
dc.contributor.author | Chan, SY | - |
dc.contributor.author | Law, SYK | - |
dc.date.accessioned | 2017-07-24T01:37:36Z | - |
dc.date.available | 2017-07-24T01:37:36Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | Hong Kong Medical Journal, 2017, v. 23 n. 3, p. 231-238 | - |
dc.identifier.issn | 1024-2708 | - |
dc.identifier.uri | http://hdl.handle.net/10722/242272 | - |
dc.description.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 after oesophageal perforation treatment. 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 Boerhaaveâ 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 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. | - |
dc.language | eng | - |
dc.publisher | Hong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/ | - |
dc.relation.ispartof | Hong Kong Medical Journal | - |
dc.rights | Hong Kong Medical Journal. Copyright © Hong Kong Academy of Medicine Press. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.title | Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies | - |
dc.type | Article | - |
dc.identifier.email | Tong, DKH: esodtong@hku.hk | - |
dc.identifier.email | Wong, YHI: iyhwong@hku.hk | - |
dc.identifier.email | Chan, SY: fsychan@hku.hk | - |
dc.identifier.email | Law, SYK: slaw@hku.hk | - |
dc.identifier.authority | Law, SYK=rp00437 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.12809/hkmj164942 | - |
dc.identifier.scopus | eid_2-s2.0-85020238083 | - |
dc.identifier.hkuros | 272943 | - |
dc.identifier.volume | 23 | - |
dc.identifier.issue | 3 | - |
dc.identifier.spage | 231 | - |
dc.identifier.epage | 238 | - |
dc.identifier.isi | WOS:000402949300005 | - |
dc.publisher.place | Hong Kong | - |
dc.identifier.issnl | 1024-2708 | - |