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Treatment of esophageal perforation in octogenarians : a multicenter study

Biancari, F; Gudbjartsson, T; Mennander, A; Hypén, L; Salminen, P; Kuttila, K; Viktorzon, M; Böckelman, C; Tarantino, E and Tiffet, O, et al. (2013) In Diseases of the Esophagus 27(8). p.8-715
Abstract

Esophageal perforation is associated with significant mortality, and this may markedly increase with advanced age. This multicenter study investigates this issue in patients older than 80 years. Data on 33 patients >80 years old who underwent conservative (10 patients), endoclip (one patient), stent grafting (11 patients), or surgical treatment (11 patients) for esophageal perforation were collected from nine centers. Surgical repair consisted of repair on drain in one patient, primary repair in seven patients, and esophagectomy in two patients. Among patients who underwent stent grafting, one required repeat stenting and another stent graft repositioning. One patient was converted to surgical repair after stent grafting. Thirteen... (More)

Esophageal perforation is associated with significant mortality, and this may markedly increase with advanced age. This multicenter study investigates this issue in patients older than 80 years. Data on 33 patients >80 years old who underwent conservative (10 patients), endoclip (one patient), stent grafting (11 patients), or surgical treatment (11 patients) for esophageal perforation were collected from nine centers. Surgical repair consisted of repair on drain in one patient, primary repair in seven patients, and esophagectomy in two patients. Among patients who underwent stent grafting, one required repeat stenting and another stent graft repositioning. One patient was converted to surgical repair after stent grafting. Thirteen patients (39.4%) died during the 30-day and/or in-hospital stay. Their mortality was significantly higher than in a series of patients<80 years old (13.0%, 21/161 patients, P=0.001). Three patients (30.0%) died after conservative treatment, one (100%) after treatment with endoclips, five (45.5%) after stent grafting, and four (36.4%) after surgical repair (P=0.548). Early survival with salvaged esophagus was 42.4% (conservative treatment: 70.0% endoclips 0%, stent grafting: 54.5%, and surgical repair: 54.5%, respectively, P=0.558). Estimated glomerular filtration rate<60 mL/minute/1.73 m2 (70.0% vs. 25.0%, P=0.043) and sepsis (100% vs. 32.1%, P=0.049) at presentation were associated with increased risk of early mortality in univariate analysis. Esophageal perforation in octogenarians is associated with very high early and intermediate high mortality irrespective of the treatment method used.

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keywords
Aged, 80 and over, Comorbidity, Esophageal Perforation, Esophagectomy, Esophagoscopy, Esophagus, Female, Humans, Length of Stay, Male, Postoperative Period, Prognosis, Retrospective Studies, Stents, Treatment Outcome, Journal Article, Multicenter Study
in
Diseases of the Esophagus
volume
27
issue
8
pages
4 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:84925934725
ISSN
1120-8694
DOI
10.1111/dote.12148
language
English
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927c5b77-0e6f-4ead-b296-a26bf3d7424a
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2016-11-17 14:03:27
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2018-06-10 05:12:26
@article{927c5b77-0e6f-4ead-b296-a26bf3d7424a,
  abstract     = {<p>Esophageal perforation is associated with significant mortality, and this may markedly increase with advanced age. This multicenter study investigates this issue in patients older than 80 years. Data on 33 patients &gt;80 years old who underwent conservative (10 patients), endoclip (one patient), stent grafting (11 patients), or surgical treatment (11 patients) for esophageal perforation were collected from nine centers. Surgical repair consisted of repair on drain in one patient, primary repair in seven patients, and esophagectomy in two patients. Among patients who underwent stent grafting, one required repeat stenting and another stent graft repositioning. One patient was converted to surgical repair after stent grafting. Thirteen patients (39.4%) died during the 30-day and/or in-hospital stay. Their mortality was significantly higher than in a series of patients&lt;80 years old (13.0%, 21/161 patients, P=0.001). Three patients (30.0%) died after conservative treatment, one (100%) after treatment with endoclips, five (45.5%) after stent grafting, and four (36.4%) after surgical repair (P=0.548). Early survival with salvaged esophagus was 42.4% (conservative treatment: 70.0% endoclips 0%, stent grafting: 54.5%, and surgical repair: 54.5%, respectively, P=0.558). Estimated glomerular filtration rate&lt;60 mL/minute/1.73 m2 (70.0% vs. 25.0%, P=0.043) and sepsis (100% vs. 32.1%, P=0.049) at presentation were associated with increased risk of early mortality in univariate analysis. Esophageal perforation in octogenarians is associated with very high early and intermediate high mortality irrespective of the treatment method used.</p>},
  author       = {Biancari, F and Gudbjartsson, T and Mennander, A and Hypén, L and Salminen, P and Kuttila, K and Viktorzon, M and Böckelman, C and Tarantino, E and Tiffet, O and Koivukangas, V and Søreide, J A and Viste, A and Bonavina, L and Vidarsdottir, H H and Saarnio, J},
  issn         = {1120-8694},
  keyword      = {Aged, 80 and over,Comorbidity,Esophageal Perforation,Esophagectomy,Esophagoscopy,Esophagus,Female,Humans,Length of Stay,Male,Postoperative Period,Prognosis,Retrospective Studies,Stents,Treatment Outcome,Journal Article,Multicenter Study},
  language     = {eng},
  month        = {10},
  number       = {8},
  pages        = {8--715},
  publisher    = {Wiley-Blackwell},
  series       = {Diseases of the Esophagus},
  title        = {Treatment of esophageal perforation in octogenarians : a multicenter study},
  url          = {http://dx.doi.org/10.1111/dote.12148},
  volume       = {27},
  year         = {2013},
}