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Updated: Jun 19, 2025

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Outcome of treatment modalities for spontaneous esophageal rupture: a meta-analysis and case series
Jiajian Pan1,2, Yong Ge1,2, Tianci Feng1,2
1Thoracic Surgery Laboratory, Xuzhou Medical University.
Background:
Current treatment modalities for spontaneous esophageal perforation remain controversial because of their rarity.
Objective:
To describe our institution's experience in managing patients with spontaneous esophageal rupture and conduct a meta-analysis of existing studies to determine the best evidence-based treatment options.
Methods:
The authors enrolled patients with spontaneous esophageal rupture who underwent their first treatment at our institution. The authors also identified studies through a systematic search of the MEDLINE, EMBASE, and Cochrane Library databases before 1 April 2024, for inclusion in the meta-analysis.
Results:
This case series included data from 17 patients with delayed diagnosis who were treated with esophageal stents, with an immediate mortality rate of 5.9%. In addition to the cases from our institution, the authors obtained 944 patients from 46 studies in the final analysis. The combined immediate mortality rate was 11% (95% CI: 0.08-0.15). The combined reintervention rate was 11% (95% CI: 0.05-0.19). The combined immediate mortality was 6% (95% CI: 0.04-0.09) after primary closure, 14% (95% CI: 0.02-0.32) after T-tube drain repair, 2% (95% CI: 0.00-0.15) after esophagectomy, 8% (95% CI: 0.03-0.15) after stent placement, and 22% (95% CI: 0.03-0.47) after conservative treatment. The subgroup analysis based on the timing of the intervention showed that the immediate mortality rate in patients initiating treatment within 24 h of rupture was 3% (95% CI: 0.01-0.08), whereas that in patients initiating treatment >24 h later was 12% (95% CI: 0.08-0.18).
Conclusion:
Outcomes are best after esophagectomy, and primary closure or esophageal stenting is a good option compared with other treatment modalities. Prognosis is related to the timing of intervention, and accurate diagnosis and treatment within 24 h significantly reduces the risk of death in patients. Patients with delayed diagnosis may have a better prognosis with stent placement.
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