Abstract
Aim
Anastomotic leakage after esophagectomy (AL) is a severe complication that often needs aggressive and invasive treatment. However, there is no consensus on what strategy is best. The aim of this study was to analyse the different treatment strategies for AL and evaluate their outcomes.
Background and methods
A retrospective analysis was performed on all patients who developed AL after Ivor Lewis Esophagectomy (IL) from January 2011 until September 2016 in three high volume hospitals. Treatment of AL was based on local expertise, without common guideline. The different treatment strategies (surgical and endoscopic) were compared for patients with contained (confined to the mediastinum) and uncontained AL (leakage with intrapleural complications).
Endpoints were the amount of re-interventions, readmission to the ICU, ICU- and hospital stay, time to restart oral feeding and mortality.
Results
Seventy-three patients with AL were identified in this multicentre cohort with either a contained or an uncontained leak. Basic variables were similar in both groups.
A contained leak was identified in 39 patients. An endoscopic approach was chosen in 25 patients (64%) and was successful in 19 (76%). Fourteen patients (36%) were primarily treated with a surgical approach that was successful in 11 (79%). Significantly more patients were (re)admitted to the ICU in the surgical group versus the endoscopic group (100% vs 52%, p=0.003). The ICU and hospital stay, time to restart oral intake and mortality were not significantly different in both groups.
An uncontained leak was seen in 34 patients. Endoscopic treatment was chosen in 14 patients (41%) and was successful in 10 (71%). A surgical approach was performed in 20 patients (59%) and was successful in 12 (60%). (Re)admission rate to the ICU was significantly higher in the surgical group (95% vs 57%, p=0.012). The ICU- and hospital stay and time to restart oral intake were similar. There was no mortality in this cohort.
Conclusion
The classification of leakages into contained and uncontained might help to determine treatment strategy. In this multicentre cohort, the endoscopic approach for contained leaks appears to be feasible and successful. The operative approach remains the preferred option for uncontained anastomotic leakage.
