Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review

Schaheen, Lara; Blackmon, Shanda H.; Nason, Katie S.

doi:10.1016/j.amjsurg.2014.05.011

Cited by 101 publications

(82 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Usually, anastomotic leak is evaluated after esophagectomy using contrast esophagogram on the seventh postoperative day (8,14,15). Its early detection is critical, as it prevents delay in therapeutic intervention and hopefully reduces its sequelae (5,6).…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

Park¹,

Kim²,

Moon³

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Anastomotic leak is one of most significant causes of mortality after esophagectomy. Therefore, it is clinically valuable to detect anastomotic leak early after esophagectomy in esophageal cancer. The purpose of this study is to investigate the associations between routine postoperative laboratory findings and anastomotic leak and to analyze the laboratory findings to find out an independent predictive marker for anastomotic leak.In addition, this study compares cases treated with neoadjuvant therapy (NT) and those without (non-NT). Methods:We retrospectively assessed the medical records of 201 consecutive cases that met this study's criteria from January 2009 to December 2016. All patients underwent curative and complete esophagectomy for intra-thoracic esophageal cancer. We compiled and analyzed routine laboratory findings from the day before surgery to the eighth postoperative day on a daily basis. Routine laboratory tests consisted of 26 separate tests, including complete blood cell counts, blood chemistries, as well as erythrocyte sedimentation rate and C-reactive protein (CRP). Barium esophagogram with chest computed tomography (CT) was performed on the seventh postoperative day to evaluate the presence of an anastomotic leak.Results: A total of 45 of 201 patients underwent NT. Anastomotic leaks were found in 23 (11.4%) of 201 patients (8 patients in NT and 15 patients in non-NT). White blood cell (WBC) from the second postoperative day (P=0.031, P=0.006, P=0.007, P=0.007, P=0.041, and P=0.003, respectively) and CRP from the third postoperative day (P=0.012, P<0.001, P=0.014, P<0.001, P=0.001, and P=0.006, respectively) were associated with anastomotic leak in non-NT; however, only CRP on the third, fifth, sixth, and seventh postoperative days (P=0.041, P=0.037, P=0.002, and P=0.003, respectively) was associated with anastomotic leak in NT. The CRP level on the third postoperative day was a significant independent predictive marker of anastomotic leak (P=0.041, odd ratio (OR) 1.056, 95% confidential interval (CI): 1.002-1.113) and had a significant diagnostic cutoff value for the development of anastomotic leak (non-NT: cutoff value 17.12 mg/dL, sensitivity 69.2%, specificity 78.1%, P<0.001, area 0.822; NT: cutoff value 16.42 mg/dL, sensitivity 80.0%, specificity 70.0 %, P=0.042, area 0.7104).Conclusions: There were divergent laboratory findings reflective of anastomotic leak between patients who underwent NT and those who did not. The CRP level on the third postoperative day had a significant cutoff value for early detection of anastomotic leak after esophagectomy in both NT and non-NT groups.

show abstract

Section: Discussionmentioning

confidence: 99%

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

Park¹,

Kim²,

Moon³

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…Based on recent improvements and developments in conservative and endoscopic treatment options, these patients can mostly be managed without surgical re-intervention, and conservative or endoscopic approaches are nowadays considered the first-choice treatment in these selected patients [1,5,14,17,19,22,[24][25][26][27][28].…”

Section: General Management Of Anastomotic Leakage and Conduit Necrosismentioning

confidence: 99%

Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

Hummel

Bausch

2017

Visc Med

View full text Add to dashboard Cite

Background: Anastomotic leakage after upper gastrointestinal surgery is associated with major morbidity and mortality. In recent years, there was a major paradigm shift in the management of leakage after upper gastrointestinal surgery from surgical towards conservative and endoscopic treatment approaches as first-line treatment options. Methods: We conducted a PubMed literature search using combinations of the keywords ‘leakage', ‘complication', ‘esophagectomy', ‘gastrectomy', and ‘pancreatectomy' to identify relevant publications. Results: Surgical re-intervention after esophagectomy, gastrectomy, or pancreatectomy is still indicated in selected patients, depending on the severity of symptoms, the condition of the patient, and failure of initiated treatment. Furthermore, surgical revision after esophagectomy and gastrectomy is indicated for early leakage and depends on the extent of anastomotic disruption and the condition of tissue. Conclusion: Surgical re-intervention still plays a crucial role in the management of leakage after upper gastrointestinal surgery, especially in critically ill patients and after failure of conservative or endoscopic treatment.

show abstract

“…However, these conservative interventions seem to be incapable to handle all the severe cases, while surgical intervention has been proved invasive and defective in consideration of the condition of patients suffering IAL (7,8). Hence, several non-surgical options have come insight these years, including endoscopic stenting, vacuum-assisted closure therapy (VACT) and naso-leakage drainage under X-ray fluoroscopy.…”

Section: Fatal Outcomes Of Ials and Non-surgical Approachesmentioning

confidence: 99%

“…Nevertheless, intrathoracic leakage carries mortality rates as high as 30%, with the incidence of 5% to 10% (6). Thus, an efficacious management of intrathoracic leakage becomes extremely urgent (7,8).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy

Zhang¹,

Zhang²,

Hu³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Intrathoracic anastomotic leakage (IAL) remains a major complication of esophagectomy.Main non-surgical options of management include chest drainage and endoscope interventions. This study is aim to present our experience and assess the efficacy of endoscopic naso-leakage drainage (ENLD) in patients with IAL. Methods: From June 2011 to January 2017, 67 patients who developed IAL after esophagectomy and managed by non-surgical approaches were analyzed retrospectively. IAL was confirmed by clinical presentations combined with the evidence of CT scan, radiography and endoscopy. Thirty-eight patients were treated by conventional chest drainage (CD group) and 29 patients underwent ENLD with or without chest drainage (ENLD group), while other treatments including enteral nutrition and antibiotics had no difference between the two groups. In ENLD group, a 12 Fr naso-leakage tube was placed through the leakage to the bottom of vomica under ultra-slim electronic gastroscope. The naso-leakage tube was then connected to a gastrointestinal decompression device for drainage and was also used for rinse. When the vomica diminished and the drainage was also clean, the naso-leakage tube could be pulled back gradually. Finally, healing of the leakage was confirmed endoscopically. Clinical records of the two groups were analyzed.Results: In ENLD group, naso-leakage tubes were successfully placed under endoscope in all 29 patients without any procedure-related complications. In CD group, the mortality is 7.9% (three patients) and five patients (13.2%) developed to systemic inflammatory response syndrome (SIRS) due to insufficient drainage.While in ENLD group, there was only one patient (3.4%) developed to SIRS and no death was observed, but the difference was not statistically significant. When compared with the CD group, the ENLD group had a shorter healing course (44.2±18.3 vs. 60.5±27.7 days, P=0.008), duration of antibiotics usage (16.4±7.8 vs.11.8±3.8 days, P<0.001) and duration of fever (4.3±2.2 vs. 9.5±8.6 days, P=0.002). Conclusions: To our initial experience, ENLD is an ideal option with safety and efficacy in management of IAL after esophagectomy.

show abstract

Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review

Cited by 101 publications

References 46 publications

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy

Contact Info

Product

Resources

About