Risk factors and consequences of anastomotic leakage after Ivor Lewis oesophagectomy

Daele, Elke Van; Putte, Dirk Van de; Ceelen, Wim; Nieuwenhove, Yves Van; Pattyn, Piet

doi:10.1093/icvts/ivv276

Cited by 82 publications

(62 citation statements)

References 14 publications

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“…Our retrospective single‐center study revealed that the incidence of AL was 7.9%, which compared favorably with the rates reported by other studies . Previous studies have revealed many predictors of AL including heart failure, smoking, hypertension, renal insufficiency, preoperative albumin, and type of procedure . Our multivariate logistic regression analysis also indicated that surgical procedure and surgeon were independent risk factors of AL after esophageal cancer surgery.…”

Section: Discussionsupporting

confidence: 86%

Risk factors for anastomotic leakage following esophagectomy: Impact of thoracic epidural analgesia

Wang

Zhao

et al. 2017

Journal of Surgical Oncology

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Section: Discussionsupporting

confidence: 86%

Risk factors for anastomotic leakage following esophagectomy: Impact of thoracic epidural analgesia

Wang

Zhao

et al. 2017

Journal of Surgical Oncology

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“…In previous reports, patients with the renal insufficiency, heart disease, diabetes, hypertension, previous stroke and chronic obstructive pulmonary disease were found to be at greater risk of developing AL [15][16][17] . Zehetner et al [18] suggested that disease processes that compromise anastomotic perfusion are major predictors of AL.…”

Section: Discussionmentioning

confidence: 99%

“…Most previous studies on the risk factors for AL after esophagectomy have involved the mediastinal route and Ivor Lewis esophagogastrectomy [15][16][17][18][19][20][21] . In our study, the subcutaneous route was found to be an independent risk factor for AL in a multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

et al. 2016

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Background/Aims: Anastomotic leakage (AL) after esophagectomy is associated with high rates of postoperative morbidity and mortality. In cases with leakage, a refractory fistula (RF) is sometimes recognized after esophagectomy. The aim of this study was to evaluate the risk factors for RF after esophagectomy with gastric tube reconstruction. Methods: This study enrolled 244 consecutive esophageal cancer patients who had undergone esophagectomy with gastric tube reconstruction. RF was defined as a noncurative anastomotic site-cutaneous fistula that had been present for more than 2 months. We evaluated the risk factors for RF. Results: AL occurred in 30 patients (12.3%). There was one mortality case (0.4%) due to mediastinitis caused by AL in the present series. A multivariate analysis revealed that the subcutaneous route was an independent risk factor for AL (OR 4.42, 95% CI 1.42-13.8, p = 0.01), and that the subcutaneous route was an independent risk factor for RF (OR 13.30, 95% CI 2.50-71.30, p = 0.0024). Conclusion: The results of this retrospective study suggest that subcutaneous route was associated with an increased risk of RF after esophagectomy with gastric tube reconstruction. The preoperative identification of risk factors may contribute to the prevention of postoperative AL and RF.

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“…It negatively affects postoperative morbidity and mortality [2], as well as recurrence-free and overall survival [3-5]. Currently, several studies have investigated patient-specific risk factors for the development of AL and described the management of postoperative AL [6, 7]. However, only few data are published on the typical time point of occurrence of postoperative AL, the favorable tool to diagnose postoperative AL (e.g., laboratory parameter analysis, endoscopy, cross-sectional imaging studies etc.)…”

Section: Introductionmentioning

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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Risk factors and consequences of anastomotic leakage after Ivor Lewis oesophagectomy

Abstract: Anastomotic leakage after oesophagectomy is a major cause of postoperative morbidity and mortality. Identifying risk factors preoperatively can contribute to the prevention of postoperative complications.

Cited by 82 publications

References 14 publications

Risk factors for anastomotic leakage following esophagectomy: Impact of thoracic epidural analgesia

Risk factors for anastomotic leakage following esophagectomy: Impact of thoracic epidural analgesia

The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

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

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