Diagnosis and management of a mediastinal leak following radical oesophagectomy

Griffin, S. M.; Lamb, PJ; Dresner, Samuel M.; Richardson, D. L.; Hayes, Nick

doi:10.1046/j.0007-1323.2001.01918.x

Cited by 172 publications

(137 citation statements)

References 7 publications

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“…Interestingly, although available studies showed that patients do not benefit from RRCS on POD 7 [16-19], between days 5 and 8 [20] or within the first postoperative week [21], only scarce data are available on the typical time point of occurrence of AL after esophagectomy. Therefore, we investigated the typical time point of occurrence of AL to evaluate if RRCS could be useful at different time points following esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

et al. 2017

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Background: Data on the typical time point of occurrence of anastomotic leak (AL) after esophagectomy for esophageal cancer are currently scarce. Therefore, the usefulness of routine radiocontrast agent studies (RRCS) for testing proper healing of the anastomosis after esophagectomy remains unclear. Furthermore, preferred available tools to diagnose postoperative AL and therapeutic options are still under debate. Methods: We present a retrospective analysis of 328 consecutive patients who underwent esophagectomy for esophageal cancer between 2005 and 2015. A RRCS has been performed to date in our center on the fifth postoperative day (POD), before returning to normal oral intake. Results: In total, 49 of 328 patients developed AL after esophagectomy (15%). A total of 11 patients (23%) developed AL before the RRCS and 34 patients (69%) after an unremarkable RRCS; and 4 patients (8%) with AL were diagnosed by RRCS, resulting in overall sensitivity of 16%. The median time point of occurrence of AL was POD 9, the majority of AL (84%) occurred between POD 1 and 19. Computed tomography led to the diagnosis of AL in 41% of patients. The most frequent therapy of AL was stenting in 47% of patients. Endoscopic vacuum therapy was used in 4 patients. Conclusions: The majority of AL occurred within the first 3 weeks after esophagectomy without a typical time point. In our series, RRCS on the fifth POD had a low sensitivity of 16%. Therefore, standardized RRCS and fasting till the examination cannot be generally recommended. In case of clinical suspicion of AL, computed tomography of the chest and abdomen with oral contrast agent should be performed, followed by endoscopy. Endoscopic stent placement remains the standard therapy of AL in our center. Endoscopic vacuum therapy evolves as it is an interesting alternative therapeutic option and can be combined with stenting in selected cases.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

et al. 2017

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“…1,2) The causes of post-operative esophageal perforation are multifactorial, and the perforation sites are the anastomosis site and the gastric conduit. 2) Clinical presentation can be divided into early fulminant, clinically silent and clinically apparent leakages.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Surgical treatment is preferred for early fulminant leakage due to partial or total necrosis of the conduit and non-surgical sealing attempts could be performed for clinically apparent post-operative anastomotic leakage. Kiev et al reported palliative management using an endoscopic PolyFlex stent for patients with mid-to distal esophageal perforations without mediastinitis.…”

Section: Discussionmentioning

confidence: 99%

“…1,2) The pathogenesis of anastomosis leakage is multifactorial and the spectrum of severity ranges from asymptomatic to systemic sepsis. 3) Khaled et al reported that the perforation occurring earlier tended to be more severe.…”

Section: Introductionmentioning

confidence: 99%

“…3) The location and extent of the perforation determine the disease severity and the appropriate treatment method. [1][2][3] However, no uniform treatment method exists for correcting post-operative intrathoracic anastomotic leakage. Recently, endoscopic vacuum-assisted closure (E-VAC) introduced as a treatment option for esophageal perforations.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Vacuum-Assisted Closure (E-VAC) Treatment in a Patient with Delayed Anastomotic Perforation following a Perforated Gastric Conduit Repair after an Ivor-Lewis Esophagectomy

Youn

Kwon

2016

ATCS

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It has been reported that intrathoracic esophageal leakages occur at a rate of 4%-17% after Ivor-Lewis esophagectomy. There has been no consensus on a specific treatment for the post-operative anastomotic leakage. Recently, endoscopic vacuum-assisted closure (E-VAC) has been introduced as a novel treatment for the post-operative anastomotic leakage. We herein report the case of a patient with early perforation of the gastric conduit followed by late esophagogastric anastomotic leakage who was successfully treated with early surgical repair and subsequent E-VAC. The patient had been previously diagnosed with achalasia and squamous cell carcinoma of the esophagus and undergone an Ivor-Lewis esophagectomy.

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Single layer versus double layer suture anastomosis of the gastrointestinal tract

Sajid¹,

Siddiqui²,

Baig³

2010

Cochrane Database of Systematic Reviews

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Diagnosis and management of a mediastinal leak following radical oesophagectomy

Cited by 172 publications

References 7 publications

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

Endoscopic Vacuum-Assisted Closure (E-VAC) Treatment in a Patient with Delayed Anastomotic Perforation following a Perforated Gastric Conduit Repair after an Ivor-Lewis Esophagectomy

Single layer versus double layer suture anastomosis of the gastrointestinal tract

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