Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer
Authors:
D. Šiška; M. Janík; K. Tarabová; P. Lauček; P. Juhos; M. Lučenič; R. Benej
Authors‘ workplace:
Klinika hrudníkovej chirurgie Slovenskej zdravotníckej univerzity a Univerzitná nemocnica Bratislava
Published in:
Rozhl. Chir., 2020, roč. 99, č. 5, s. 200-206.
Category:
Review
doi:
https://doi.org/10.33699/PIS.2020.99.5.200–206
Overview
Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.
Keywords:
oesophageal cancer – oesophagectomy complication – anastomic leak – management of dehiscence – oesophageal stent
Sources
- Schuchert MJ, Abbas G, Nason KS, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery 2010;148:831–840. doi:10.1016/j.surg.2010.07.034.
- Bardini R, Asolati M, Ruol A, et al. Anastomosis. World J Surg. 1994;18:373–378. doi:10.1007/bf00316817.
- Veeramootoo D, Parameswaran R, Krishnadas R, et al. Classification and early recognition of gastric conduit failure after minimally invasive esophagectomy. Surg Endosc. 2009;23:2110–2116. doi:10.1007/s00464-008-0233-1.
- Michelet P, D’Journo X, Roch A, et al. Perioperative risk factors for anastomotic leakage after esophagectomy: influence of thoracic epidural analgesia. Chest 2005;128:3461–3466. doi:10.1378/chest.128.5.3461.
- Whooley BP, Law S, Alexandrou A, et al. Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg. 2001;181(3):198–203. doi: 10.1016/s0002-9610(01)00559-1.
- Lorentz T, Fok M, Wong J. Anastomotic leakage after resection and bypass for esophageal cancer: lessons learned from the past. World J Surg. 1989;13(4):472–477. doi: 10.1007/bf01660760
- Blewett C J, Miller J D, Young J E, et al. Anastomotic leaks after esophagectomy for esophageal cancer: a comparison of thoracic and cervical anastomoses. Ann Thorac Cardiovasc Surg. 2001;7(2):75–78.
- Patil PK, Patel SG, Mistry RC, et al. Cancer of the esophagus: esophagogastric anastomotic leak–a retrospective study of predisposing factors. J Surg Oncol. 1992;49(3):163–167. doi: 10.1002/jso.2930490307
- Dent B, Griffin SM, Jones R, et al. Management and outcomes of anastomotic leaks after oesophagectomy. Br J Surg. 2016;103:1033−1038. doi:10.1002/bjs.10175.
- Manghelli JL, Ceppa DP, Greenberg JW, et al. Management of anastomotic leaks following esophagectomy: when to intervene? J Thorac Dis. 2019;11(1):131–137. doi: 10.21037/jtd.2018.12.13.
- Larburu Etxaniz S1, Gonzales Reyna J, Elorza Orúe JL, et al. Cervical anastomotic leak after esophagectomy: Diagnosis and management. [Article in Spanish] Cir Esp. 2013; 91(1):31–37. doi: 10.1016/j.ciresp.2012.09.005.
- Lerut T, Coosemans W, Decker G, et al. Anastomotic complications after esophagectomy. Dig Surg. 2002;19:92–8. doi: 10.1159/000052018.
- Hlavatý T, Koller T, Tóth J, et al. Expandibilné stenty v liečbe benígnych a malígnych ochorení pažeráka. Gastroent Hepatol. 2014: 68(5):441−450.
- Cassivi S D. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg. 2004;16:124–132. doi: 10.1053/j.semtcvs.2004.03.011.
- Martin LW, Hofstetter W, Swisher SG, et al. Management of intrathoracic leaks following esophagectomy. Adv Surg. 2006;40:173–190. doi: 10.1016/j.yasu.2006.05.010
- Kassis ES, Kosinski AS, Ross P, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg. 2013;96:1919–1926. doi: 10.1016/j.athoracsur.2013.07.119.
- Peracchia A, Bardini R, Ruol A, et al. Esophagovisceral anastomotic leak. A prospective statistical study of predisposing factors. J Thorac Cardiovasc Surg. 1988;95:685–691.
- Lerut T, Coosemans W, De Leyn P, et al. Optimizing treatment of carcinoma of the esophagus and gastroesophageal junction. Surg Oncol Clin North Am. 2001;10:863–884. https://doi.org/10.1016/S1055-3207(18)30037-1.
- Junemann-Ramirez M, Awan MY, Khan ZM, et al. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg. 2005;27:3–7. doi: 10.1016/j.ejcts.2004.09.018.
- Juntang Guo, Xiangyang Chu, Yang Liu, et al. Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy. World Journal of Surgical Oncology 2014;12:402. doi: 10.1186/1477-7819-12-402.
- Briel JW, Tamhankar AP, Hagen JA, et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 2004;198:536–542. doi: 10.1016/j.jamcollsurg.2003.11.026.
- Anbari MM, Levine MS, Cohen RB, et al. Delayed leaks and fistulas after esophagogastrectomy: radiologic evaluation. AJR Am J Roentgenol. 1993;160:1217–1220. doi: 10.2214/ajr.160.6.8498220.
- Verstegen MH, Bouwense SAW, Workum F, et al. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review. World J Emerg Surg. 2019;14:17. doi: 10.1186/s13017-019-0235-4.
- Scharf JG, Ramadori G, Becker H, et la. Implantation of a colorectal stent as a therapeutic approach in the treatment of esophageal leakage. BMC Gastroenterol. 2007;7:10. doi: 10.1186/1471-230X-7-10.
- Pross M, Manger T, Reinheckel T, et al. Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc. 2000;51:73–76. doi: 10.1016/s0016-5107(00)70391-9.
- Chen L, Liu F, Wang K, et al. Omentoplasty in the prevention of anastomotic leakage after oesophagectomy: a meta-analysis. Eur J Surg Oncol. 2014;40:1635–1640.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2020 Issue 5
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