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Significant decrease of mortality due to anastomotic leaks following esophageal resection: management makes the difference

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Abstract

Purpose

Anastomotic leakage is the most frequent cause of postoperative mortality following esophageal surgery. However, no gold standard for diagnosing and managing leakage has been established. Continuous clinical judgment is extremely important; therefore, to optimize the management of leakage, we established a special group for decision-making in cases of suspected leakage in the early postoperative period.

Methods

Between January 2010 and December 2016, 234 consecutive patients underwent elective esophageal resection with a thoracoabdominal incision. In 2014, we established a group consisting of a surgeon, surgical endoscopist, and anesthesiologist for decision-making in cases of suspected leakage. They discussed emerging problems and decided on further diagnostics or therapy. The data were documented prospectively and compared to the years prior to 2014.

Results

Two hundred and thirty-four consecutive patients were enrolled in the study, 110 in the years 2010–2013 (group A), and 124 in the years 2014–2016 (group B). Neither patients’ characteristics nor the rate of anastomotic leakage differed significantly between the two study groups. The hospital mortality rate was 10% (11 patients) in group A and 4.8% (six patients) in group B. Most interestingly, mortality due to anastomotic leakage was 35% in group A (9/26), whereas it decreased significantly to 6.5% (2/31 patients) (P < 0.001) in group B.

Conclusions

Our data clearly demonstrated that optimizing the management of anastomotic leakage by making team decisions can lead to a significant decrease in mortality.

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Author information

Authors and Affiliations

  1. Department of General Surgery, Heidelberg University Hospital, INF 110, 69120, Heidelberg, Germany

    Anja Schaible, Ulf Hinz, Thomas Schmidt, Markus W. Büchler & Alexis Ulrich

  2. Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany

    Thorsten Brenner & Markus Weigand

  3. Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany

    Peter Sauer

Authors
  1. Anja Schaible
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  2. Thorsten Brenner
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  3. Ulf Hinz
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  4. Thomas Schmidt
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  5. Markus Weigand
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  6. Peter Sauer
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  7. Markus W. Büchler
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  8. Alexis Ulrich
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Contributions

Anja Schaible: study conception and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript. Thorsten Brenner: critical revision of the manuscript. Ulf Hinz: analysis and interpretation of data and critical revision of the manuscript. Thomas Schmidt: critical revision of the manuscript. Markus Weigand: critical revision of the manuscript. Peter Sauer: acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript. Markus W. Büchler: critical revision of the manuscript. Alexis Ulrich: analysis and interpretation of data and critical revision of the manuscript.

Corresponding author

Correspondence to Anja Schaible.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Schaible, A., Brenner, T., Hinz, U. et al. Significant decrease of mortality due to anastomotic leaks following esophageal resection: management makes the difference. Langenbecks Arch Surg 402, 1167–1173 (2017). https://doi.org/10.1007/s00423-017-1626-1

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  • DOI: https://doi.org/10.1007/s00423-017-1626-1

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