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Original Articles: General Thoracic

Invited Commentary

Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 445, Houston, TX 77030-4009

(Email: whofstetter@mdanderson.org).

The first 20% of the full text of this article appears below.

This article by Kotzampassakis and colleagues [1] provides more evidence that the management of spontaneous and iatrogenic esophageal perforations presenting with sepsis can result in excellent outcomes. Their results are impressive, considering where we have come from. When originally described, esophageal perforations were uniformly fatal, and in past decades, we applauded novel treatments that led to improvements away from high, double-digit mortality. Very low mortality is the current new standard, and this article reports 0% in-hospital mortality.

Substantial changes have occurred in the management trends for this type of high-risk visceral perforation. Early treatment attempts focused on observation and drainage, resulting in extraordinarily high mortality rates. Later, recommendations for a surgical approach with decortication, drainage, and primary closure of the esophageal defect improved outcomes [2. . . [Full Text of this Article]

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Ann. Thorac. Surg. 2009 88: 966-972. [Abstract] [Full Text] [PDF]