Esophagogastrectomy: Reoperation for complications

Matory, Yvedt L.; Burt, Michael

doi:10.1002/jso.2930540109

Cited by 35 publications

(19 citation statements)

References 23 publications

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“…They suggest that patients with non-contained leaks with clinical signs of sepsis should be resuscitated and re-explored in the operating room. They also recommend that the pleural cavity and mediastinum be debrided and drained (4,18). Although intuitive to an extent, it is important to recognize that not all leaks require aggressive interventions.…”

Section: Discussionmentioning

confidence: 99%

Management of anastomotic leaks following esophagectomy: when to intervene?

et al. 2019

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Background: Esophagectomy is the mainstay treatment for early stage and locoregionally advanced esophageal cancer. Anastomotic leaks following esophagectomy are associated with numerous detrimental sequelae. The management of anastomotic leaks has evolved over time. The present study is a singleinstitution experience of esophageal leak management over an 11-year period, in order to identify when these can be managed nonoperatively. Methods: All patients undergoing esophagectomy with gastric reconstruction at our institution between 2004 and 2014 were identified. Preoperative patient characteristics and perioperative factors were reviewed. Failure of initial leak treatment was defined as need for escalation of therapy. Length of stay (LOS) and postoperative mortality were the primary outcomes. Follow-up was obtained through institutional medical records and the Social Security Death Index. Results: Sixty-one of 692 (8.8%) patients developed an anastomotic leak. Forty-six patients (75.4%) first underwent observation, which was successful in 35 patients. Predictors of successful observation included higher preoperative albumin (P=0.02), leak diagnosed by esophagram (P=0.004), and contained leaks (P=0.01). Successful observation was associated with shorter LOS (P=0.001). Predictors of mortality included lower preoperative serum albumin (P=0.01) and induction therapy (P=0.03). Thirty and 90-day mortality among patients who developed an anastomotic leak were 9.8% and 16.7%, respectively. Conclusions: Over half of anastomotic leaks were managed successfully with observation alone and did not require additional interventions. We have identified factors that may predict successful therapy with observation in these patients. Further research is warranted to determine more timely interventions for patients likely to fail conservative management.

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Section: Discussionmentioning

confidence: 99%

Management of anastomotic leaks following esophagectomy: when to intervene?

et al. 2019

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“…The most effective treatment option for esophagogastric anastomotic leaks is controversial, and there is no standardized treatment algorithm. While some surgeons recommend aggressive surgery, others prefer conservative approaches including perianastomotic drainage, total parenteral nutrition, nasogastric decompression, and the use of broad‐spectrum antibiotics 3,8,10,11 . Recently, the use of self‐expandable metallic coated stents resulted in considerable improvement of thoracic anastomotic leaks 12–15 …”

Section: Introductionmentioning

confidence: 99%

The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma

Türkyılmaz

Eroğlu

Aydın

et al. 2009

Diseases of the Esophagus

134

123

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Esophagogastric anastomotic leaks are the most feared surgical complications following resection of esophageal cancers. We aimed to develop a therapeutic algorithm for this complication characterized by high morbidity and mortality using our 20 years of experience and the published literature. A total of 354 patients who had undergone an esophagectomy and esophagogastric anastomosis due to esophageal carcinoma were evaluated retrospectively. The incidence for anastomotic leak was 15.5% (n = 90) in the cervical region and 4.2% (n = 264) in the thoracic region (mean: 7.1%). Cervical anastomotic leaks were detected after a mean period of 7.2 days following the procedure. Fourteen patients with cervical leaks were treated conservatively. Four out of 14 patients (28.6%) died due to sepsis and multi-organ failure related to fistula. Thoracic anastomotic leaks were detected after a mean period of 4.7 days following the procedure. Emergency reoperation, resection and reconstruction procedures were performed in one patient. Self-expanding metallic coated stents were placed at the anastomosis region in two patients. A more conservative approach was employed in other patients with thoracic anastomotic leaks. Six of them (46.2%) died due to fistula. General mortality rate was 37.0%, and the duration of hospitalization was 40.0 days for patients with anastomotic leaks. Cervical anastomotic leaks are more common than thoracic anastomotic leaks, but most of them are successfully treated with conservative approaches. Thoracic anastomotic leaks that in the past were related to high mortality rates despite conservative or surgical procedures might be successfully treated nowadays with the use of self-expanding metallic coated stents.

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“…Factors influencing surgical decision process include the mode of presentation, symptomatic or asymptomatic and the postoperative course [6]. Keeping in mind the high mortality (O40%) for patients requiring a second intervention [7], careful consideration is necessary to decide if the patient might benefit from a second surgical intervention or not.…”

Section: Introductionmentioning

confidence: 99%