Strategia terapeutica attuale nelle perferorazioni dell'esofago

Background. Esophageal perforation still represents a challenging therapeutic problem. The aim of this study was to analyze retrospectively the results of surgical and conservative therapy in our series. Methods. Over the last 20 years, 147 patients with esophageal perforation have been observed and treated. Ninety-two percent of the lesions were iatrogenic. The perforation was located in the thoracic esophagus in 105 patients, cervical esophagus in 32, and abdominal esophagus in 10. Surgical drainage was the most common procedure performed in patients with cervical and abdominal perforations; in those with thoracic perforation the treatment was tailored to the individual patient according to the operative risk, the status of the esophageal wall, and the magnitude of the fistula. Conservative therapy was preferred in most patients with underlying esophageal disease. Results. The overall mortality rate was 17.6%, and was greater in patients with diagnostic delay than in those treated early (21.3 vs 15.1%, p = NS). Mortality was less during the past decade of the study period compared to the first decade (11.3% vs 25%, p < 0.05). No significant differences in mortality were observed according to the type of treatment. The mortality rates for perforation of the cervical and abdominal esophagus were 9.3% and 20%, respectively. Conclusions. Mortality rates for esophageal perforation have significantly decreased during the past decade. This may be due to improved selection of the therapeutic options in the individual patient, and better resuscitation, antibiotic, and nutritional supports.