scholarly journals Variations in treatment of an anastomotic leakage after Ivor Lewis Esophagectomy

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Merel Lubbers ◽  
◽  
Frans van Workum ◽  
Gijs Berkelmans ◽  
Camiel Rosman ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Surgical Approach ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Admission Rate ◽  
High Volume ◽  
Ivor Lewis ◽  
Endoscopic Techniques ◽  
Ivor Lewis Esophagectomy ◽  
Surgical Group

Background: Anastomotic Leakage (AL) after Ivor Lewis Esophagectomy (ILE) is a severe complication that often needs immediate treatment. However, there is no consensus on the optimal treatment. The aim of this study was to describe the outcomes of the different treatment options in patients with either contained or uncontained AL after ILE. Methods: A retrospective analysis was performed on patients that developed AL after ILE in three high volume hospitals. Treatment was based on local preference. Endoscopic and surgical treatment were compared for patients with either contained (leakage confined to the mediastinum) or uncontained AL (leakage with intrapleural manifestations). Results: In total, 73 patients with an AL were included. A contained leak was observed in 39 patients. Twenty-five patients (64%) underwent an endoscopic approach that was successful in 19 patients (76%); fourteen patients (36%) underwent a surgical approach that was successful in 11 patients (79%). Significantly more patients were (re)admitted to the ICU in the surgical group; other outcomes were similar. An uncontained leak was observed in 34 patients. Endoscopic treatment was chosen in 14 patients (41%) and was successful in 10 patients (71%). A surgical approach was performed in 20 patients (59%) and was successful in 12 patients (60%). (Re) admission rate to the ICU was significantly higher in the surgical group, other outcomes were similar. Conclusions: This study demonstrates that there is high variability in the treatment of AL after esophagectomy. Surgical and endoscopic techniques are both successfully used for patients with either contained or uncontained leakages. However, more research is necessary before a treatment algorithm can be developed. Keywords: esophageal cancer; esophageal surgery; minimally invasive surgery; anastomotic leakage; endoscopic procedures.

scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

2022 ◽  
Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
High Volume ◽  
Gastric Conduit ◽  
Common Finding ◽  
Type Ii ◽  
Ivor Lewis ◽  
Stapling Device ◽  
Ivor Lewis Esophagectomy ◽  
Cervical Reconstruction ◽  
Prolonged Hospital

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

P42 EFFICACY OF ENDOSCOPIC TREATMENT FOR CONTAINED LEAKAGE AFTER IVOR LEWIS ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
M Lubbers ◽  
Workum F van ◽  
G Berkelmans ◽  
C Rosman ◽  
MD Luyer ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Surgical Approach ◽  
Endoscopic Treatment ◽  
Treatment Strategies ◽  
Oral Intake ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Stay Time ◽  
Multicentre Cohort ◽  
Surgical Group

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.

PS02.147: MANAGEMENT OF A SIMULTANEOUS HIGH ESOPHAGO-TRACHEAL FISTULA CAUSED BY ESOPHAGEAL STENT DUE TO ANASTOMOTIC LEAKAGE AFTER IVOR-LEWIS ESOPHAGECTOMY: A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 162-162
Author(s):  
Hannah Andrae ◽  
Thomas Musholt ◽  
Hauke Lang ◽  
Peter Grimminger
Keyword(s):  
Case Report ◽  
Anastomotic Leakage ◽  
Healing Process ◽  
Esophageal Stent ◽  
Neoadjuvant Radiochemotherapy ◽  
Carcinoma Of The Esophagus ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
First Choice ◽  
Cervical Surgery

Abstract Background Esophagotracheal perforation is a very severe complication. However, an esophagotracheal perforation caused due to an esophageal stent after anastomotic leakage after ivor-lewis resection, is even more complex and associated with high mortality. Therefore we present a case how we managed a high esophagotracheal perforation and anastomotic leakage after ivor-lewis resection of esophageal cancer, prior treated with neoadjuvant radiochemotherapy. Methods Case report A 71-year old patient was transferred to our center due to an esophagotracheal perforation at the proximal stent—and at 18–20 cm from the front teeth row. The stent had been placed due to anastomotic leakage after ivor-lewis resection. The patient's history began with a squamous cell carcinoma of the esophagus, treated with neoadjuvant radiochemotherapy and followed by ivor-lewis esophagectomy. She developed an anastomotic leakage, which was treated with an esophageal stent. This stent perforated and caused a fistula between the esophagus and the trachea. Results After transfer to our center, we performed a tracheotomia with a tubus blocked, distal of the esophagotracheal fistula, to prevent a respiratory insufficiency. We removed the dislocated stent and induced an endosponge therapy. A prolonged healing process lead to a step-by-step decrease of the anastomotic leakage. Finally, the semicircular hole could be supplied by a fibrin sealant. We resected the fistula via cervical surgery and placed a pectoralis muscle flap between trachea and esophagus. The surgery was performed under steady neuromonitoring control. The postoperative course was uncomplicated. The patient could be extubated with spontaneous breathing. Eleven days after surgery, the patient could be discharged fully enteralised. The stomach interponate could be kept. Half a year later, our patient shows up in our regular consultation, reporting no dysphagia. Conclusion Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection. A stenting of the esophagus after finding an anastomotic leakage can be considered, but is associated with a risk of further complication. Disclosure All authors have declared no conflicts of interest.

792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Berend Van Der Wilk ◽  
Eliza R C Hagens ◽  
Ben M Eyck ◽  
Suzanne S Gisbertz ◽  
Richard Hillegersberg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Hospital Length Of Stay ◽  
Mortality Data ◽  
Study Group ◽  
Ivor Lewis ◽  
Open Esophagectomy ◽  
Ivor Lewis Esophagectomy ◽  
The Impact

Abstract   To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy. Methods Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models. Results In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy. Conclusion Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.

scholarly journals Aortic Calcification Increases the Risk of Anastomotic Leakage After Ivor-Lewis Esophagectomy

2016 ◽  
Vol 102 (1) ◽  
pp. 247-252 ◽  
Author(s):  
Lucas Goense ◽  
Peter S.N. van Rossum ◽  
Teus J. Weijs ◽  
Marc J. van Det ◽  
Grard A. Nieuwenhuijzen ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Aortic Calcification ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

scholarly journals Outcomes of Patients with Anastomotic Leakage After Transhiatal, McKeown or Ivor Lewis Esophagectomy: A Nationwide Cohort Study

2021 ◽  
Author(s):  
Moniek H. P. Verstegen ◽  
Annelijn E. Slaman ◽  
Bastiaan R. Klarenbeek ◽  
Mark I. van Berge Henegouwen ◽  
Suzanne S. Gisbertz ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Anastomotic Leakage ◽  
Readmission Rate ◽  
Strong Association ◽  
Postoperative Mortality ◽  
Transhiatal Esophagectomy ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Operation Rate ◽  
Different Types

Abstract Background Anastomotic leakage has a great impact on clinical outcomes after esophagectomy. It has never been studied whether anastomotic leakage is of equal severity between different types of esophagectomy (i.e., transhiatal, McKeown and Ivor Lewis) in terms of postoperative mortality and morbidity. Methods All esophageal cancer patients with anastomotic leakage after transhiatal, McKeown or Ivor Lewis esophagectomy between 2011 and 2019 were selected from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) registry. The primary outcome was 30-day/in-hospital mortality. Secondary outcomes included postoperative complications, re-operation and ICU readmission rate. Results Data from 1030 patients with anastomotic leakage after transhiatal (n=287), McKeown (n=397) and Ivor Lewis esophagectomy (n=346) were evaluated. The 30-day/in-hospital mortality rate was 4.5% in patients with leakage after transhiatal esophagectomy, 8.1% after McKeown and 8.1% after Ivor Lewis esophagectomy (P=0.139). After correction for confounders, leakage after transhiatal resection was associated with lower mortality (OR 0.152–0.699, P=0.004), but mortality after McKeown and Ivor Lewis esophagectomy was similar. Re-operation rate was 24.0% after transhiatal, 40.6% after McKeown and 41.3% after Ivor Lewis esophagectomy (P<0.001). ICU readmission rate was 24.0% after transhiatal, 37.8% after McKeown and 43.4% after Ivor Lewis esophagectomy (P<0.001). Conclusion This study in patients with anastomotic leakage confirms a strong association between severity of clinical consequences and different types of esophagectomy. It supports the hypothesis that cervical leakage is generally less severe than intrathoracic leakage. The clinical impact of anastomotic leakage should be taken into account, in addition to its incidence, when different types of esophagectomy are compared by clinicians or researchers.

130 SEVERITY OF ANASTOMOTIC LEAKAGE AFTER DIFFERENT TYPES OF ESOPHAGECTOMY: A NATIONWIDE COHORT STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Moniek Verstegen ◽  
Annelijn Slaman ◽  
Bastiaan Klarenbeek ◽  
Mark Berge Henegouwen ◽  
Suzanne Gisbertz ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Surgical Techniques ◽  
Composite Endpoint ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Confounding Variables ◽  
Mckeown Esophagectomy

Abstract   Orringer, McKeown and Ivor Lewis esophagectomy are the most commonly performed procedures for esophageal and gastro-esophageal junction cancer. Anastomotic leakage remains a major problem after all types of esophagectomy and it is currently unknown whether anastomotic leakage severity is different between the types of esophagectomy. The aim of this study was to investigate the relationship between surgical techniques and the severity of anastomotic leakage in patients after Orringer esophagectomy, McKeown esophagectomy or Ivor Lewis esophagectomy. Methods All esophageal and gastro-esophageal junction cancer patients with anastomotic leakage after Orringer, McKeown or Ivor Lewis esophagectomy between 2011 and 2019 were selected from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). The primary outcome parameter was a composite endpoint of reoperation, intensive care unit (ICU) readmission and 30-day/in-hospital mortality. Secondary outcome parameters included postoperative complications, re-intervention rate, ICU and hospital length of stay. Results Data from 1034 patients with anastomotic leakage after Orringer (n = 287), McKeown (n = 397) and Ivor Lewis esophagectomy (n = 346) were evaluated. The primary endpoint occurred in 36.3% of patients with anastomotic leakage after Orringer esophagectomy, in 55.4% of patients with anastomotic leakage after McKeown esophagectomy and in 61.2% of patients with anastomotic leakage after Ivor Lewis esophagectomy (p &lt; 0.001). When adjusting for potential confounding variables, the sequelae of anastomotic leakage after Orringer and McKeown esophagectomy remained less severe compared to anastomotic leakage after Ivor Lewis esophagectomy (OR 0.28, 95% CI 0.20–0.41, p &lt; 0.001 and OR 0.71, 95% CI 0.52–0.97, p = 0.031, respectively). Conclusion Consequences of anastomotic leakage are most severe after Ivor Lewis esophagectomy, moderately severe after McKeown esophagectomy and least severe after Orringer esophagectomy. This study demonstrated that not only the incidence, but also the severity of anastomotic leakage should be considered in current clinical practice and in studies that compare leakage rates between different surgical techniques of esophagectomy.

Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Brian Housman ◽  
Dong‐Seok Lee ◽  
Andrea Wolf ◽  
Daniel Nicastri ◽  
Andrew Kaufman ◽  
...  
Keyword(s):  
Esophageal Stricture ◽  
Gastric Leak ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy
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