Seven Year Prognosis and Surgical Techniques of Thoracic Esophageal Perforation Treatment

Abstract

Considering the high mortality rate associated with esophageal perforation, as well as the potential for errors in early diagnosis and the lack of sufficient comparative studies on treatment methods, this study aimed to investigate the most commonly used surgical methods for thoracic esophageal perforation at Imam Reza Hospital. The goal was to determine the surgical techniques and complications related to each type of surgery, identify the best surgical method for reducing complications, mortality, and costs for patients, based on statistical results obtained. The study aimed to compare treatment methods and the seven-year prognosis of thoracic esophageal perforation. Methods: This study was a cross-sectional analytical study. The study population consisted of 69 individuals who were referred to Imam Reza Hospital between 2015 and 2022. These individuals had a primary or final diagnosis of thoracic esophageal perforation caused by iatrogenic factors or foreign bodies, and they were hospitalized and undergoing treatment. Excluded from the study population were individuals under 18 years old or over 80 years old, patients with underlying cardiopulmonary disease or metastatic cancers, and patients who had mediastinitis at the time of referral. The patients were followed up by contacting them, and the person making the calls collected information on the treatment method, prognosis, surgical procedure, morbidity, and mortality of each patient using an information collection checklist. After completing the study and data collection, statistical analysis was performed using SPSS software and appropriate statistical methods. Results: Analysis of the management methods for patients with esophageal perforation revealed that drainage procedures through thoracotomy and esophagectomy with reconstruction were the most commonly used methods. The highest mortality rates were observed in thoracostomy (2 out of 10 patients), esophagogastrectomy without reconstruction (2 out of 11 patients), and drainage procedures through thoracotomy (3 out of 18 patients). In total, 10 out of 69 patients (14.47 percent) died. The investigation into the impact of different surgical methods on the mortality rate of the study participants indicated that only drainage procedures through thoracotomy significantly increased mortality and reduced survival (p=0.045), while other methods did not have a significant effect on survival (p>0.05). Furthermore, it was found that T-tube drain (p=0.019) and esophagectomy with reconstruction (p=0.027) significantly improved the survival of the patients participating in the study, whereas other methods did not have a significant effect on survival.