Perianastomotic drainage in Ivor-Lewis esophagectomy, does habit affect utility? An 11-year single-center experience

  • C. A. De PasqualEmail author
  • J. Weindelmayer
  • S. Laiti
  • R. La Mendola
  • M. Bencivenga
  • L. Alberti
  • S. Giacopuzzi
  • G. de Manzoni
Original Article


Anastomotic leakage (AL) is a deadly complication after Ivor-Lewis esophagectomy. The use of an anastomotic drainage (AD), to diagnose and to potentially treat the leakage, is still a widespread practice. At present, scientific literature is lacking in this topic and its use is based on each center experience. We performed a retrospective analysis of 239 consecutive patients who underwent an Ivor-Lewis esophagectomy in our Department from 01/01/2006 to 31/12/2017. Until 28/02/2014, a transthoracic anastomotic drainage was routinely placed in 119 patients (anastomotic-drain group). Drainage removal was planned on POD 5 after the resume of oral intake. In the remaining 120 cases, no drainage was placed (no anastomotic-drain group). We compared the two groups to assess whether the anastomotic drainage had an impact on the timing of the anastomotic leakage diagnosis and treatment. In our series, we observed 9 anastomotic leaks in the first group (7.6%) and 3 in the second one (2.5%). In the anastomotic-drain group, median time for leak diagnosis was 10 days, and notably, in seven cases, the anastomotic drainage was already removed. Considering all the patients who experienced an AL, a re-operation was mandatory in one case, while endoscopic treatment was chosen for five cases and conservative treatment was adopted in three cases. The median hospital length of stay in these patients was 31 days. In the no anastomotic-drain group, one patient with anastomotic leakage was treated conservatively and discharged after 34 days. The other two cases were re-operated and an esophageal prosthesis was placed in both cases, and these patients were discharged, respectively, on POD 28 and POD 38. Concluding, the role of the anastomotic drain in Ivor-Lewis esophagectomy is still unclear. There is a shortage of the literature on this topic and our experience shows that the anastomotic drain has a limited sensibility in AL diagnosis and cannot replace the clinical signs and symptoms. Moreover, the drain it is often removed before the leakage becomes visible. In selected patients with a less severe leak, the anastomotic drain can be an effective treatment, but often a percutaneous drainage, it is an effective alternative choice. In severe dehiscence with sepsis, a reoperation remains the mainstay to control the mediastinal contamination and to eventually treat the leakage.


Esophagectomy Anastomotic leakage Esophago-gastric anastomosis 


Author contribution

C.A. De Pasqual gave substantial contribution to the conception, acquisition, and analysis of the work, contributed to drafting, and approved the final version of the manuscript. J. Weindelmayer gave substantial contribution to conception of the work and interpretation of the data, contributed to drafting and revising of the paper, and approved the final version of the manuscript. S. Laiti, R. La Mendola, and L. Alberti gave substantial contribution to acquisition of data and contributed to revising of the work. They approved the final version of the manuscript. M. Bencivenga and S. Giacopuzzi gave substantial contribution to conception and interpretation of the data. Both contributed to revising of the paper. They approved the final version of the manuscript. G. de Manzoni gave substantial contribution to conception and interpretation of the data, contributed to revising of the paper, and approved the final version of the manuscript.


No sources of support have been used for this paper.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors have no affiliations with or involvement in any organization or entity with any financial interest.

Informed consent

No informed consent is required.


  1. 1.
    Lordick F, Mariette C, Haustermans K, Obermannová R, Arnold D (2016) Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 27(suppl 5):50–57CrossRefGoogle Scholar
  2. 2.
    National Comprehensive Cancer Network Guidelines for Patients with Esophageal Cancer (NCCN). Version 1.2016Google Scholar
  3. 3.
    Gockel I, Niebisch S, Ahlbrand CJ et al (2016) Risk and complication management in esophageal cancer surgery: a review of the literature. Thorac Cardiovasc Surg 64(7):596–605CrossRefGoogle Scholar
  4. 4.
    Cassivi SD (2004) Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg 16(2):124–132CrossRefGoogle Scholar
  5. 5.
    Messager M, Warlaumont M, Renaud F et al (2017) Recent improvements in the management of esophageal anastomotic leak after surgery for cancer. Eur J Surg Oncol 43(2):258–269CrossRefGoogle Scholar
  6. 6.
    Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS (2005) Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on long-term survival in a high volume centre. Eur J Cardiothorac Surg 27(1):3–7CrossRefGoogle Scholar
  7. 7.
    Low DE, Kuppusamy MK, Alderson D et al (2017) Benchmarking complications associated with esophagectomy. Ann Surg 269:291–298CrossRefGoogle Scholar
  8. 8.
    Zhou C, Ma G, Li X et al (2015) Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol 13:269CrossRefGoogle Scholar
  9. 9.
    Low DE, Kuppusamy MK, Alderson D et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy. Ann Surg 262(2):286–294CrossRefGoogle Scholar
  10. 10.
    Melloul E, Hübner M, Scott M et al (2016) Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 40(10):2425–2440CrossRefGoogle Scholar
  11. 11.
    Wang Z, Chen J, Su K, Dong Z (2015) Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst Rev 5:008788Google Scholar
  12. 12.
    Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, Law S, Lindblad M, Maynard N, Neal J, Pramesh CS, Scott M, Mark Smithers B, Addor V, Ljungqvist O (2018) Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 43:299–330CrossRefGoogle Scholar
  13. 13.
    Zanoni A, Verlato G, Giacopuzzi S et al (2013) Neoadjuvant concurrent chemoradiotherapy for locally advanced esophageal cancer in a single high-volume center. Ann Surg Oncol 20(6):1993–1999CrossRefGoogle Scholar
  14. 14.
    Giacopuzzi S, Weindelmayer J, Treppiedi E et al (2017) Enhanced recovery after surgery protocol in patients undergoing esophagectomy for cancer: a single center experience. Dis Esophagus 30(4):1–6CrossRefGoogle Scholar
  15. 15.
    Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefGoogle Scholar
  16. 16.
    Kassis ES, Kosinski AS, Ross P Jr, Koppes KE, Donahue JM, Daniel VC (2013) Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg 96(6):1919–1926CrossRefGoogle Scholar
  17. 17.
    Tang H, Xue L, Hong J, Tao X, Xu Z, Wu B (2012) A method for early diagnosis and treatment of intrathoracic esophageal anastomotic leakage: prophylactic placement of a drainage tube adjacent to the anastomosis. J Gastrointest Surg 16(4):722–727CrossRefGoogle Scholar
  18. 18.
    Baker EH, Hill JS, Reames MK, Symanowski J, Hurley SC, Salo JC (2016) Drain amylase aids detection of anastomotic leak after esophagectomy. J Gastrointest Oncol 7(2):181–188Google Scholar
  19. 19.
    Berkelmans GHK, Kouwenhoven EA, Smeets BJJ et al (2015) Diagnostic value of drain amylase for detecting intrathoracic leakage after esophagectomy. World J Gastroenterol 21(30):9118–9125CrossRefGoogle Scholar
  20. 20.
    Perry Y, Towe CW, Kwong J, Ho VP, Linden PA (2015) Serial drain amylase can accurately detect anastomotic leak after esophagectomy and may facilitate early discharge. Ann Thorac Surg 100(6):2041–2046CrossRefGoogle Scholar
  21. 21.
    Siu WT, Chung SC, Li AK (1992) Chest drain penetration into the transposed stomach after Ivor-Lewis esophagectomy: diagnosis by early postoperative endoscopy. Surg Endosc 6(4):195–196CrossRefGoogle Scholar
  22. 22.
    Gossage JA, Chukwuemeka AO, Dussek JE (2003) Intercostal drain migration post esophagectomy. Dis Esophagus 16(3):268–269CrossRefGoogle Scholar
  23. 23.
    Wilmot AS, Levine MS, Rubesin SE, Kucharczuk JC, Laufer I (2007) Intraluminal migration of surgical drains after transhiatal esophagogastrectomy: radiographic findings and clinical relevance. AJR Am J Roentgenol 189(4):780–785CrossRefGoogle Scholar
  24. 24.
    Weindelmayer J, Verlato G, Alberti L, Poli R, Priolo S, Bovo C, de Manzoni G (2018) Enhanced recovery protocol in esophagectomy, is it really worth it? A cost analysis related to team experience and protocol compliance. Dis Esophagus 32:114 (Epub ahead of print) CrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.General and Upper GI Surgery DivisionUniversity of VeronaVeronaItaly

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