Abstract
BackgroundThe aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy.MethodsClinical data from 33 patients who developed intrathoracic anastomotic leak were evaluated retrospectively. These patients were selected from 1867 patients undergoing resection carcinoma of the esophagus and reconstruction between January 2003 and December 2012.ResultsSurgical intervention and the reformed “three-tube method” were applied in 13 and 20 patients, respectively. The overall incidence of intrathoracic anastomotic leakage was 1.8%. The median time interval from esophagectomy to diagnosis of leak was 9.7 days. Sixteen patients were confirmed as having leakage by oral contrast computed tomography (CT). Age and interval from surgery to diagnosis of leak were identified as statistically significant parameters between contained and uncontained groups. Moreover, patients with hypoalbuminemia had a longer time to leak closure than patients without hypoalbuminemia. Six patients died from intrathoracic anastomotic leak, with a mortality rate of 18.2%. There was no statistically significant difference in the time to leak closure between patients who underwent surgical exploration and those who received conservative treatment.ConclusionsIntrathoracic anastomotic leak after esophagectomy was associated with significant mortality. Once intrathoracic anastomotic leakage following esophagectomy was diagnosed or highly suspected, individualized management strategies should be implemented according to the size of the leak, extent of the abscess, and status of the patient. In the majority of patients with anastomotic leak, we preferred the strategy of conservative treatment.
Highlights
The aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy
Intrathoracic esophagogastric anastomotic leak following esophagectomy is the most feared complication of esophageal resection because it is associated with high morbidity and mortality [1,2]
The cancer was located at the gastroesophageal junction in 6 patients, medium thoracic esophagus in 21 patients, distal esophagus in 5 patients, and upper thoracic esophagus in 1 patient
Summary
The aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy. Intrathoracic esophagogastric anastomotic leak following esophagectomy is the most feared complication of esophageal resection because it is associated with high morbidity and mortality [1,2]. The presentation of intrathoracic esophageal leak ranges from patients who are asymptomatic to those with circulatory collapse and multiple organ failure. The severity of presentation is largely dependent on the magnitude of the leak and whether the pleural space is contaminated. Because of this broad clinical spectrum, it is difficult to establish a standard strategy for diagnosis and treatment. The “three-tube method” is the most widely applied conservative treatment for intrathoracic anastomotic leak Some surgeons recommend aggressive surgery, while others prefer conservative approaches [3,4,5].
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