Abstract
BackgroundAnastomotic leakage (0–30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy have the best clinical outcome, based on the currently available literature.MethodsA systematic literature search was performed in Medline, Embase, and Web of Science until April 2017. All studies reporting on the specific treatment of cervical or intrathoracic anastomotic leakage following esophagectomy with gastric tube reconstruction for esophageal or cardia cancer were included. The primary outcome parameter was postoperative mortality. Methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale.ResultsNineteen retrospective cohort studies including 273 patients were identified. Methodological quality of all studies was poor to moderate. Mortality rates of intrathoracic anastomotic leakages in the treatment groups were as follows: conservative (14%), endoscopic stent (8%), endoscopic drainage (8%), endoscopic vacuum-assisted closure system (0%), and surgery treatment group (50%). Mortality rates of cervical anastomotic leakages in the treatment groups were as follows: conservative (8%), endoscopic stent (29%), and endoscopic dilatation (0%).DiscussionDue to small cohorts, heterogeneity between studies, and lack of data regarding leakage characteristics, no evidence supporting a specific treatment for anastomotic leakage after esophagectomy was found. A severity score based on leakage characteristics instead of treatment given is essential for determining the optimal treatment of anastomotic leakage. In the absence of robust evidence-based treatment guidelines, we suggest customized treatment depending on sequelae of the leak and clinical condition of the patient. PrDepartment of Surgery, Radboudumc, P.O.B. 9101/618 NLactical advices are provided.Trial registrationRegistration number PROSPERO: CRD42016032374.
Highlights
Anastomotic leakage (0–30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality
The incidence of anastomotic leakage could be calculated in only 2 studies; the incidence rates were 1% and 17%, respectively [16, 20]
Tumor characteristics were reported in 2 studies; in 1 study, stage I esophageal cancer was found in 3 patients, stage IIA in 9, stage IIB patients in 11 patients, and stage III in 5 patients [33]
Summary
Anastomotic leakage (0–30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy have the best clinical outcome, based on the currently available literature. Anastomotic leakage (0–30%) is a severe complication after esophagectomy [3, 4]. The occurrence of anastomotic leakage is associated with a prolonged length of stay on the intensive care unit (ICU) and within the hospital, a reduced quality of life, high costs, and an increased mortality rate [4–7]. Factors that influence the severity of anastomotic leakage might impact the most appropriate treatment strategy. No generally accepted treatment strategy for the treatment of anastomotic leakage after esophagectomy currently exists [10]
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