{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T23:22:48Z","timestamp":1784330568387,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Oesophageal perforation (OP) is a life-threatening condition requiring prompt diagnosis and treatment. Mortality is influenced by several factors, such as aetiology, defect location, comorbidities, age, and delays in treatment. This study reviews patients with OP undergoing surgery, analysing mortality risks and the impact of timing on surgical outcomes. Methods: Medical records of 45 patients surgically treated for OP across three tertiary centers were analysed. Results: Of the 45 patients, 31 were male (68.88%) and 14 were female (31.11%), with a mean age of 66.00 \u00b1 17.75 years. Pre-operative CT was performed in all patients, and 18 (40%) underwent oesophagogastroduodenoscopy. As many as 25 patients (55.55%) presented within 24 h, 10 (22.22%) within 24\u201372 h, and 10 (22.22%) after 72 h. Symptoms included pain, vomiting, fever, dysphagia, and subcutaneous emphysema. Foreign body ingestion and Boerhaave\u2019s syndrome were the leading causes (33.33% each), followed by caustic ingestion (17.77%) and iatrogenic and traumatic cases. Treatments included primary repair, debridement, oesophagectomy, and oesophagogastrectomy. Primary repair was performed in 22 cases (48.88%), and muscle flaps reinforced 11 of these. Direct repair showed the highest success rate when performed within 24 h. Thirty patients (66.66%) experienced complications, including respiratory failure, oesophagopleural fistula, and sub-stenosis. The hospital stay average was 36.34 \u00b1 35.03 days. Nine patients underwent same-session\/two-stage gastroplasty or retrosternal coloplasty for reconstruction, with complications including stenosis and leaks. Six patients (13.33%) died within the first 24 h after surgery, primarily due to severe comorbidities (three (50%) were octogenarians). Conclusions: OP is a life-threatening condition with high mortality. Primary repair is the preferred treatment. Oesophagectomy and gastrectomy are reserved for extensive lesions. Muscle flaps can reinforce sutures in cervical and thoracic perforations. Mortality is mainly influenced by the severity of the patient\u2019s clinical picture and comorbidities, rather than by time and type of treatment.<\/jats:p>","DOI":"10.3390\/jcm14124019","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T09:02:03Z","timestamp":1749200523000},"page":"4019","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Oesophageal Perforation Surgical Treatment: What Affects the Outcome? A Multicenter Experience"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4058-5539","authenticated-orcid":false,"given":"Antonio Giulio","family":"Napolitano","sequence":"first","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00136 Rome, Italy"},{"name":"Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2937-9678","authenticated-orcid":false,"given":"Dania","family":"Nachira","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00136 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Petracca Ciavarella","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00136 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1963-8592","authenticated-orcid":false,"given":"Eleonora","family":"Coviello","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4553-3973","authenticated-orcid":false,"given":"Domenico","family":"Pourmolkara","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Vaz Sousa","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Meacci","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00136 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1061-5773","authenticated-orcid":false,"given":"Tiziano","family":"De Giacomo","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Venuta","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venanzio","family":"Porziella","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00136 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Margaritora","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00136 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Puma","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Vannucci","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13017-019-0245-2","article-title":"Esophageal emergencies: WSES guidelines","volume":"14","author":"Chirica","year":"2019","journal-title":"World J. Emerg. 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