615. TREATMENT PATTERN AND OUTCOMES OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY

Abstract

Abstract Anastomotic leak (AL) is one of the most common complications after esophagectomy and is frequently associated with repeated interventions; nothing by mouth (NPO), endoscopic vacuum therapy (EVT), or surgery. This study aimed to evaluate treatment pattern and its outcomes for patients with AL after esophagectomy. We retrospectively reviewed patients who underwent esophagectomy at a single center from 2003 to 2020. A total of 3096 patients were reviewed and 181 (5.8%) patients with AL, excluding graft necrosis, were included in this study. We classified patients with AL according to the site of the anastomosis; 114 (63%) patients with cervical anastomosis (CA) and 67 (37%) patients with intrathoracic anastomosis (TA). The incidence of AL was 11.9% and 3.2% in patients with CA and TA, respectively (p < 0.001). For patients with CA, 87 (76.3%), 15 (13.2%) and 12 (10.5%) patients were treated with NPO, EVT and surgery, respectively. Consequently, more than 90% of CA patients achieved oral diet at discharge regardless of management. For patients with TA, 36 patients underwent NPO (53.7%), of which 34 achieved oral diet. In addition, 25 patients were treated with EVT (37.3%), and 19 achieved oral diet. However, only 2 out of 6 patients treated with surgery achieved oral intake and 2 required subsequent EVT. In patients with CA, the incidence rate of AL was higher, nevertheless, success rate of oral diet was higher than in patients with TA regardless of management. For AL in patients with TA, EVT applied more frequent than in patient with CA, and seems to be effective therapy.