Management of anastomotic leaks following esophagectomy: When to intervene?

Joshua L. Manghelli, Mimi Ceppa, Jason W. Greenberg, David Blitzer, Adam Hicks, Karen Rieger, Thomas Birdas

Research output: Contribution to journalArticle

Abstract

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 single-institution 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.

Original languageEnglish (US)
Pages (from-to)131-137
Number of pages7
JournalJournal of Thoracic Disease
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Anastomotic Leak
Esophagectomy
Observation
Mortality
Length of Stay
Therapeutics
Social Security
Esophageal Neoplasms
Serum Albumin
Medical Records
Albumins
Stomach

Keywords

  • Anastomotic leak
  • Esophageal cancer
  • Esophagectomy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Management of anastomotic leaks following esophagectomy : When to intervene? / Manghelli, Joshua L.; Ceppa, Mimi; Greenberg, Jason W.; Blitzer, David; Hicks, Adam; Rieger, Karen; Birdas, Thomas.

In: Journal of Thoracic Disease, Vol. 11, No. 1, 01.01.2019, p. 131-137.

Research output: Contribution to journalArticle

Manghelli, Joshua L. ; Ceppa, Mimi ; Greenberg, Jason W. ; Blitzer, David ; Hicks, Adam ; Rieger, Karen ; Birdas, Thomas. / Management of anastomotic leaks following esophagectomy : When to intervene?. In: Journal of Thoracic Disease. 2019 ; Vol. 11, No. 1. pp. 131-137.
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