Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review

Abstract

Background Anastomotic leakage (0–30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy have the best clinical outcome, based on the currently available literature. Methods A systematic literature search was performed in Medline, Embase, and Web of Science until April 2017. All studies reporting on the specific treatment of cervical or intrathoracic anastomotic leakage following esophagectomy with gastric tube reconstruction for esophageal or cardia cancer were included. The primary outcome parameter was postoperative mortality. Methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Results Nineteen retrospective cohort studies including 273 patients were identified. Methodological quality of all studies was poor to moderate. Mortality rates of intrathoracic anastomotic leakages in the treatment groups were as follows: conservative (14%), endoscopic stent (8%), endoscopic drainage (8%), endoscopic vacuum-assisted closure system (0%), and surgery treatment group (50%). Mortality rates of cervical anastomotic leakages in the treatment groups were as follows: conservative (8%), endoscopic stent (29%), and endoscopic dilatation (0%). Discussion Due to small cohorts, heterogeneity between studies, and lack of data regarding leakage characteristics, no evidence supporting a specific treatment for anastomotic leakage after esophagectomy was found. A severity score based on leakage characteristics instead of treatment given is essential for determining the optimal treatment of anastomotic leakage. In the absence of robust evidence-based treatment guidelines, we suggest customized treatment depending on sequelae of the leak and clinical condition of the patient. PrDepartment of Surgery, Radboudumc, P.O.B. 9101/618 NLactical advices are provided. Trial registration Registration number PROSPERO: CRD42016032374 . Electronic supplementary material The online version of this article (10.1186/s13017-019-0235-4) contains supplementary material, which is available to authorized users.

Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

“…Our anastomotic leaks accounted for 2(4%), of the deaths and had a 2/7 (28 %) mortality which is comparatively higher than a 12 % mortality from anastomotic leak found in a systematic review done by Verstegenet al 28 and other recent data 30 but comparable to the 37 % mortality reported by Turkyilmaz A et al 29 Even though Gockel and colleges 9 in their study involving 424 patients suggested that tumor characteristics, e.g. TNM classi cation, were of no in uence on the postoperative course our study, however, found that N3 stage, hence stage III disease, is signi cantly associated with adverse short term postoperative outcomes (AOR 0.04 (0.01-0.97 p= 0.048).…”

Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

“…Our anastomotic leaks accounted for 2(33.3%),of the deaths and had a 2/7 (28.5 %) mortality which is comparatively higher than a 12 % mortality from anastomotic leak found in a systematic review done by Verstegenet al 28 and other recent data 30 but comparable to the 37 % mortality reported by Turkyilmaz A et al 29 Even though Gockel and colleges 9 in their study involving 424 patients suggested that tumor characteristics, e.g. TNM classi cation, were of no in uence on the postoperative course our study ,however, found that N3 stage, hence stage III disease, is signi cantly associated with adverse short term postoperative out comes (AOR 0.04 (0.01-0.97 p= 0.048) .…”

Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients

“…Our anastomotic leaks accounted for 2(4%), of the deaths and had a 2/7 (28 %) mortality which is comparatively higher than a 12 % mortality from anastomotic leak found in a systematic review done by Verstegenet al 28 and other recent data 30 but comparable to the 37 % mortality reported by Turkyilmaz A et al 29 In 3 cases there was part of a tumor leftover as it was deemed dangerous to proceed with complete tumor removal due to the T4b stage of the tumor. These were not avoided from pre-operative work due to a combination of pre-operative radiologic imaging's' failure to properly identify the stage of the tumor, the fact that there are very few oncologic units which are overwhelmed by oncologic patients and the lack of esophageal stenting for palliation.…”