Early detection of complications: anastomotic leakage

Moon, Seok Whan; Kim, Jae Jun; Cho, Deog Gon; Park, Jae Kil

doi:10.21037/jtd.2018.11.55

Cited by 27 publications

(19 citation statements)

References 51 publications

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“…Studies have shown that early detection of anastomotic leakage and the formation of a multidisciplinary collaborative group to make treatment decisions reduces the patient mortality rate. 5,6 Therefore, the early identification of anastomotic leakage is of great significance to patient prognosis. Currently, the clinical diagnosis of anastomotic leakage in esophageal cancer primarily includes esophageal endoscopy, barium meal angiography, and staining (methylthionine chloride) swallowing.…”

Section: Discussionmentioning

confidence: 99%

Constructing a risk prediction model for anastomotic leakage after esophageal cancer resection

Sun

Jia-rui

et al. 2020

J Int Med Res

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The purpose of this study was to investigate a newly constructed risk prediction model for anastomotic leakage after esophageal cancer resection. Methods: A retrospective survey of 205 patients who underwent esophageal cancer resection was conducted using a self-designed questionnaire. The influencing factors were explored by single factor analysis, and a logistic regression analysis was performed to construct the prediction equation. A receiver operating characteristic curve was used to evaluate the model. Results: The incidence of anastomotic leakage after esophageal cancer resection was 11.73%. There were five independent risk factors entered into the regression equation. The risk prediction equation was Z ¼ 0.108 Â age þ 2.011 Â preoperative chemotherapy history þ 3.007 Â incision redness/exudation þ 2.632 Â pleural effusion þ 1.934 Â increased white blood cell count À 12.304. According to the receiver operating characteristic curve test, the area under the curve was 0.946, the sensitivity was 0.833, the specificity was 0.912, and the Youden index was 0.745. Conclusion: The risk model of anastomotic leakage after esophageal cancer resection had a good predictive effect that was of significance for guiding clinical observation and early-screening.

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Section: Discussionmentioning

confidence: 99%

Constructing a risk prediction model for anastomotic leakage after esophageal cancer resection

Sun

Jia-rui

et al. 2020

J Int Med Res

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“…Zur Diagnostik stehen generell klinische und laborchemische Parameter sowie bildgebende Verfahren (Endoskopie, Röntgenkontrastverfahren, Schnittbildgebung) zur Verfügung. Die frühzeitige Identifizierung senkt die Morbidität und Mortalität [ 1 , 2 ].…”

Section: Diagnostikunclassified

Postoperative Leckagen im Gastrointestinaltrakt – Diagnostik und Therapie

et al. 2022

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ZusammenfassungPostoperative Leckagen nach Ösophagus‑, Magen- oder Kolon- bzw. Rektumchirurgie stellen schwerwiegende chirurgische Komplikationen mit einer hohen Morbidität und Mortalität dar. Leckagen werden zumeist durch eine Kombination aus klinischer Beobachtung, Infektionsparametern sowie endoskopischen und schnittbildgebenden Verfahren diagnostiziert. Die Therapie ist bei intraperitonealen Leckagen chirurgisch, bei retroperitonealen bzw. mediastinalen Leckagen in einem interdisziplinären Setting überwiegend interventionell endoskopisch. Hier stehen der Defektverschluss durch die Abdichtung mittels selbstexpandierender gecoverter Stents mit gleichzeitiger externer extraluminaler Drainage sowie der Defektverschluss mit simultaner innerer Drainage und endoskopischer Unterdrucktherapie als vorrangige Methoden zur Verfügung.

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“…Clinical presentations of anastomotic leakage are diverse and varies from asymptomatic to severely septic patients. Clinical distinction between anastomotic leakage and other complications such as pneumonia and systemic inflammatory response syndrome (SIRS) is challenging as clinical symptoms are near to identical (11,12). Therefore, leakage is mainly detected using a combination of clinical, endoscopic and radiological evaluation.…”

Section: Introductionmentioning

confidence: 99%

The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging

Plat¹,

Bootsma²,

Straatman³

et al. 2020

J Thorac Dis

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Background: CT imaging is the primary diagnostic approach to assess the integrity of the intrathoracic anastomosis following Ivor Lewis esophagectomy. In the postoperative setting interpretation of CT findings, such as air and fluid collections, may be challenging. Establishment of a scoring system that incorporates CT findings to diagnose anastomotic leakage could assist radiologists and surgeons in the postoperative phase.Methods: Consecutive patients who underwent a CT scan for a clinical suspicion of postoperative anastomotic leakage following Ivor Lewis esophagectomy between 2010 and 2016 in two medical centers were retrospectively included. Scans were excluded when oral contrast was not (correctly) administered.Acquired images were randomized and independently assessed by two experienced gastrointestinal radiologists, blinded for clinical information. For this study anastomotic leakage was defined as a visible defect during endoscopy or thoracotomy. Results: A total of 80 patients had 101 CT scans, resulting in 32 scans with a confirmed anastomotic leak (25 patients). After multivariable backward stepwise logistic regression, a practical 5-point scoring system was developed, which included the following CT findings: presence of extraluminal oral contrast, air collection at the anastomotic site, fluid collection at the anastomotic site, pneumothorax and loculated pleural effusion.Patients with a score of ≥3 were considered at high risk for anastomotic leakage (positive predictive value: 83.3%), patients with scores <3 were considered at low risk for anastomotic leakage (negative predictive value: 84.4%). The scoring system showed a superior diagnostic performance compared to the original CT report and blinded interpretation of two radiologists. Conclusions: Our CT-based practical scoring system enables a standardized approach in CT assessment and could facilitate early recognition of anastomotic leakage in patients after Ivor Lewis esophagectomy.

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Early detection of complications: anastomotic leakage

Cited by 27 publications

References 51 publications

Constructing a risk prediction model for anastomotic leakage after esophageal cancer resection

Constructing a risk prediction model for anastomotic leakage after esophageal cancer resection

Postoperative Leckagen im Gastrointestinaltrakt – Diagnostik und Therapie

The clinical suspicion of a leaking intrathoracic esophagogastric anastomosis: the role of CT imaging

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