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We appreciate Dr. Heitmiller’s [1Heitmiller R.F. Intrathoracic manifestation of cervical anastomotic leaks (letter).Ann Thorac Surg. 2006; 82: 383Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] comments regarding our study [2Korst R.J. Port J.L. Lee P.C. Altorki N.K. Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma.Ann Thorac Surg. 2005; 80: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar] describing the intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy. In his letter he states that our conclusion from this study is that cervical anastomotic leaks are more common after esophagectomy with thoracotomy than after transhiatal esophagectomy. Furthermore he believes that cervical leaks occur more frequently when a thoracotomy is performed because of residual pneumothorax after chest tube removal.In our article we made no conclusion comparing the rate of anastomotic leakage after either thansthoracic or transhiatal esophagectomy. Rather we concluded that intrathoracic manifestations occurred in 52% of patients with cervical anastomotic leaks in our series of patients who underwent transthoracic esophagectomy with cervical anastomosis. This figure is appreciably higher than that previously published for cervical anastomotic leaks after transhiatal esophagectomy. We then speculated as to the reasons why sepsis seems to spread more readily to the thoracic cavity despite placement of the anastomosis in the neck, and we surmised that it could be due to the more extensive dissection at the thoracic inlet, which is performed in patients who undergo thoracotomy compared with the transhiatal patients. In addition, an increase in negative intrathoracic pressure due to chest tube suction may be playing a role as well. In our patients, it is not uncommon for the chest tubes to remain in place for as much as 1 week after resection. We appreciate Dr. Heitmiller’s [1Heitmiller R.F. Intrathoracic manifestation of cervical anastomotic leaks (letter).Ann Thorac Surg. 2006; 82: 383Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] comments regarding our study [2Korst R.J. Port J.L. Lee P.C. Altorki N.K. Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma.Ann Thorac Surg. 2005; 80: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar] describing the intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy. In his letter he states that our conclusion from this study is that cervical anastomotic leaks are more common after esophagectomy with thoracotomy than after transhiatal esophagectomy. Furthermore he believes that cervical leaks occur more frequently when a thoracotomy is performed because of residual pneumothorax after chest tube removal. In our article we made no conclusion comparing the rate of anastomotic leakage after either thansthoracic or transhiatal esophagectomy. Rather we concluded that intrathoracic manifestations occurred in 52% of patients with cervical anastomotic leaks in our series of patients who underwent transthoracic esophagectomy with cervical anastomosis. This figure is appreciably higher than that previously published for cervical anastomotic leaks after transhiatal esophagectomy. We then speculated as to the reasons why sepsis seems to spread more readily to the thoracic cavity despite placement of the anastomosis in the neck, and we surmised that it could be due to the more extensive dissection at the thoracic inlet, which is performed in patients who undergo thoracotomy compared with the transhiatal patients. In addition, an increase in negative intrathoracic pressure due to chest tube suction may be playing a role as well. In our patients, it is not uncommon for the chest tubes to remain in place for as much as 1 week after resection. Intrathoracic Manifestation of Cervical Anastomotic LeaksThe Annals of Thoracic SurgeryVol. 82Issue 1PreviewKorst and colleagues [1] published a single institution review of 242 patients who underwent transthoracic esophagectomy with cervical anastomosis. The incidence of anastomotic leak was 11.1%. Over half (52%) of these patients had an intrathoracic manifestation of the cervical leak. They conclude that compared with transhiatal esophagectomy, cervical anastomotic leaks are more common with transthoracic esophagectomy methods. The authors hypothesize that the reasons for this finding could include transmediastinal infection of the pleural space while constructing the cervical anastomosis, chest tube suction, or size (larger) of the leak. Full-Text PDF