Postoperative outcome after surgical treatment of esophageal perforations – a retrospective cohort study of patients with different etiologies and treatment approaches

Abstract

Esophageal perforations (EPs) are a rare and life-threatening condition with diverse treatment options [1–5]. Current evidence guiding management remains limited. This study reports a 13-year institutional experience with surgical and endoscopic treatment of EP at a high-volume center. 71 consecutive patients with EPs treated between 01/2012 and 06/2025 were analyzed. Patients with anastomotic leaks after upper gastrointestinal surgery were excluded. EPs were categorized by anatomical location (cervical, thoracic, abdominal) and initial treatment strategy: open surgery (OS), minimally invasive surgery (MIS), or endoscopic therapy (ET). Primary endpoints were postoperative complications according to the Clavien–Dindo Classification and in-hospital mortality, while secondary endpoints included operation time, postoperative revisions, ICU length of stay and hospital length of stay. The endpoints were analyzed across EP locations and treatment strategies. Thoracic perforations were most common (56%), followed by abdominal (37%) and cervical perforations (7%). Initial treatment included MIS in 38%, ET in 35%, and OS in 27% of patients. Operative time was significantly shorter with ET (40 min) compared with MIS (115 min) and OS (197 min; p  < 0.001). Treatment within 24 h was associated with fewer severe postoperative complications (52% vs. 76%, p  = 0.038) and lower in-hospital mortality (8% vs. 31%, p  = 0.031). Primary endoscopic stent placement was associated with fewer major complications (54% vs. 82%, p  = 0.011) and shorter hospital and ICU stays. Overall, in-hospital mortality was 23% and differed significantly by EP location (cervical 0%, thoracic 35%, abdominal 4%; p  = 0.005). Outcomes after EP are strongly influenced by perforation location and timing of treatment. Early intervention and minimally invasive approaches incorporating endoscopic stent placement may reduce postoperative morbidity.