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The Optimal Treatment Strategy for Postoperative Anastomotic Leakage After Esophagectomy: a Comparative Analysis Between Endoscopic Vacuum Therapy and Conventional Treatment

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

We compared the clinical outcomes between endoscopic vacuum therapy (EVT) and conventional treatment (CT) for the management of post-esophagectomy anastomotic leakage.

Methods

A retrospective review of the medical records of patients who underwent esophagectomy with esophagogastrostomy from November 2003 to August 2021 was conducted. Thirty-four patients who developed anastomotic leakage were analyzed according to whether they underwent CT (n = 13) or EVT (n = 21).

Results

The median time to complete healing was significantly shorter in the EVT group than in the CT group (16 [4–142] days vs. 70 [8–604] days; p = 0.011). The rate of clinical success was higher in the EVT group (90.5%) than in the CT group (66.7%, p = 0.159). A subgroup analysis showed more favorable outcomes for EVT in patients with thoracic leakage, including a higher clinical success rate (p = 0.037), more rapid complete healing (p = 0.004), and shorter hospital stays (p = 0.006). However, the results were not significantly different in patients with cervical leakage. Anastomotic strictures occurred in 3 EVT patients (14.3%) and 5 CT patients (50.0%) (p = 0.044), and the EVT group showed a trend towards improved freedom from anastomotic strictures (p = 0.105).

Conclusions

EVT could be considered as an adequate treatment option for post-esophagectomy anastomotic leakage. EVT might have better clinical outcomes compared to CT for managing anastomotic leakage after transthoracic esophagogastrostomy, and further studies are needed to evaluate the effectiveness of EVT in patients who undergo cervical esophagogastrostomy.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by grant no. 02–2018-0044 from the SNUBH Research Fund.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea

    Joonseok Lee, Jae Hyun Jeon, Seung Hwan Yoon, Beatrice Chia-Hui Shih, Woohyun Jung, Yoohwa Hwang, Sukki Cho, Kwhanmien Kim & Sanghoon Jheon

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  1. Joonseok Lee
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Contributions

- Joonseok Lee: 1st author: prepared manuscript and participated in data analysis.

- Jae Hyun Jeon: corresponding author: prepared manuscript and participated in supervision

- Seung Hwan Yoon: participated in data analysis and supervision

- Beatrice Chia-Hui Shih: participated in data analysis and supervision

- Woohyun Jung: participated in data analysis and supervision

- Yoohwa Hwang: participated in data analysis and supervision

- Sukki Cho: participated in data analysis and supervision

- Kwhanmien Kim: participated in data analysis and supervision

- Sanghoon Jheon: participated in data analysis and supervision

Corresponding author

Correspondence to Jae Hyun Jeon.

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Ethnic Approval

This study protocol was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB number: B-2205–755-110).

Informed Consent

The requirement for informed consent was waived because of the retrospective study design.

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The authors declare no competing interests.

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Lee, J., Jeon, J.H., Yoon, S.H. et al. The Optimal Treatment Strategy for Postoperative Anastomotic Leakage After Esophagectomy: a Comparative Analysis Between Endoscopic Vacuum Therapy and Conventional Treatment. J Gastrointest Surg 27, 2899–2906 (2023). https://doi.org/10.1007/s11605-023-05637-5

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