Aim: Surgical resection remains the treatment of choice for curable esophageal cancer patients. Anastomotic leakage after esophagectomy with an intrathoracic anastomosis is the most feared complication, and is the main cause of postoperative morbidity and mortality. The aim of this study was to identify risk factors associated with anastomotic leakage and its effect on the postoperative outcome. Methods: Between 2012 and 2022, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. We performed a retrospective analysis of 174 patients. The dataset was analyzed to identify risk factors for the occurrence of anastomotic leakage. Results: A total of 174 patients were evaluated. The overall anastomotic leakage rate was 18.96%. The 30-day mortality rate was 8.62%. Multivariate logistic regression analysis identified diabetes (p = 0.0020) and obesity (p = 0.027) as independent risk factors associated with anastomotic leakage. AL had a drastic effect on the combined ICU/IMC and overall hospital stay (p < 0.001. Conclusion: Anastomotic leakage after esophagectomy with intrathoracic anastomosis is the most feared complication and major cause of morbidity and mortality. Identifying risk factors preoperatively can contribute to better patient management.
Introduction: Anastomotic leakage (AL) following oesophageal surgery is the most feared complication. Therefore, it is of utmost importance to diagnose it in a timely and safe manner. The diagnostic algorithm, however, differs across institutions world-wide, with no clear consensus or guidelines. The aim of this study was to analyse whether computed tomography (CT) or upper endoscopy (UE) should be performed first. Material and Methods: Records of 185 patients undergoing oesophageal surgery for underlying malignancy were analysed. All patients that developed an AL were further analysed. Results of CT and UE were compared to calculate sensitivity. Results: Overall, 33 out of 185 patients were diagnosed with an AL after oesophagectomy. All patients received a CT and a UE. The CT identified 23 out of 33 patients correctly. Sensitivity was 69.7% for CT, compared to 100% for UE. Conclusion: If patients are clinically suspicious regarding development of an AL after oesophagectomy, UE should be performed prior to CT as it has a sensitivity of 100%. In addition, treatment by means of endoluminal vacuum therapy (EVT) or self-expanding-metal stents (SEMS) can be initiated promptly.
Background and Objectives: Though widely used, only limited data is available that shows the superiority of hybrid minimally-invasive esophagectomy (HMIE) compared to open esophagectomy (OE). The present study aimed to analyze postoperative morbidity, mortality, and compare lengths of hospital stay. Materials and Methods: A total of 174 patients underwent Ivor Lewis esophagectomy in our surgical department, of which we retrospectively created a matched population of one hundred (HMIE n = 50, OE n = 50). Morbidity and mortality data was categorized, analyzed, and risk factor analyzed for complications. Results: The oncological results were found to be comparable in both groups. A median of 23.5 lymphnodes were harvested during OE, and 21.0 during HMIE. Negative tumor margins were achieved in 98% of OE and 100% of HMIE. In-hospital mortality rate showed no significant difference between techniques (OE 14.0%, HMIE 4.0%, p = 0.160). Hospital (OE Median 23.00 days, HMIE 16.50 days, p = 0.004) and ICU stay (OE 5.50 days, HMIE 3.00 days, p = 0.003) was significantly shorter after HMIE. The overall complication rate was 50%, but complications in general (OE 70.00%, HMIE 30%, p < 0.001) as well as severe complications (Clavien Dindo ≥ III: HMIE 16.0%, OE 48.0%, p < 0.001) were significantly more common after OE. In multivariate stepwise regressions the influence of OE proved to be independent for said outcomes. We observed more pulmonary complications in the OE group (46%) compared to HMIE patients (26%). This difference was statistically significant after adjustment for sex, age, BMI, ASA classification, histology, neoadjuvant treatment or not, smoking status, cardiac comorbidities, diabetes mellitus, and alcohol abuse (p = 0.019). Conclusions: HMIE is a feasible technique that significantly decreases morbidity, while ensuring equivalently good oncological resection compared to OE. HMIE should be performed whenever applicable for patients and surgeons.
Summary Background Anastomotic insufficiency of the esophagus is the most feared complication of surgeons, leading to high postoperative morbidity and mortality. However, there is no internationally accepted guideline for its classification and treatment algorithm. Therefore, the aim of this study was to analyze the detection of anastomotic leaks as well as to discuss and validate the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound in late 2018. Methods All patients undergoing surgery for malignancy of the esophagogastric junction between 2013 and 2020 were analyzed. Out of these patients, those diagnosed with an anastomotic insufficiency were extracted and classified according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Continuous variables were expressed as medians, categorical variables were compared using Fisher’s exact test or chi-square test. Results From 2013 to 2020, all 23 patients (10.84%) who developed an anastomotic leak after esophageal surgery were included in this study. The study revealed a significant increase in median hospital stay, median intensive care unit stay, and overall mortality rate (p = 0.028) with increased classification type. Conclusion The results of this study showed that the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound can be validated and that there is a clear differentiation between the subtypes. Standardized diagnosis and management improve the overall outcome of patients. Main novel aspects This article gives an introduction to classifying anastomotic insufficiencies according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Results of the classification can be validated, with a clear differentiation of postoperative outcome between subtypes.
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