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Ann Thorac Surg 2004;77:2264
© 2004 The Society of Thoracic Surgeons

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Correspondence

Esophageal perforations

Division of Cardiothoracic Surgery, University of Tennessee, Health Science Center, 956 Court Ave, Memphis, TN 38163, USA

e-mail: jpate{at}utmem.edu

To the Editor:

The excellent report on esophageal perforations by Port and colleagues [1] again demonstrates the important principle that the interval between perforation and presentation is not a valid contraindication to surgical repair even though one must expect far more major complications in those patients whose diseases are diagnosed late.

However, their Table 5 contains an error and, more importantly, seems to compare series but fails to indicate the major differences between those series. Prognosis—of death and major complications—is related to varying causes and underlying pathology; these are not differentiated in Table 5. One should compare instrumental perforations (19 in this report) only with instrumental perforations and Boerhaave's (2 in this report) with only Boerhaave's perforation. This mixing of groups of diffuse causes and pathophysiologies is a common practice in most reports of esophageal perforations. Prognoses and surgical risks of all patients are not the same.

The error is in reporting: our report [2] actually contained 8 patients who had repair more than 24 hours after presentation, not NS as shown in Table 5. Our series of 34 patients, all with Boerhaave's perforations, should not be compared with patients with instrumental perforations—particularly those after extractions of foreign bodies or achalasia.

The authors should be congratulated on their superb results in this series, which adds support to the concept that all esophageal perforations should be repaired when technically feasible.

References

1. Port J.L., Kent M.S., Korst R.J., Bacchetta M., Altorki N.K. Thoracic esophageal perforations: a decade of experience. Ann Thorac Surg 2003;74:1071-1074.
2. Pate JW, Walker WA, Cole FH Jr, Owen EW, Johnson WH. Spontaneous rupture of the esophagus: a 30-year experience. Ann Thorac Surg 1989;47:689–92

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James W. Pate Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pate, J. W. Search for Related Content PubMed Articles by Pate, J. W. Related Collections Esophagus - other