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Diagnosis and management of anastomotic leaks after Ivor Lewis esophagectomy: a single-center experience

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Abstract

Purpose

Esophageal anastomotic leaks (ALs) after esophagectomy are a common and serious complication. The incidence, diagnostic approach, and management have changed over time. We described the diagnosis and management of patients who developed an esophageal AL after an Ivor Lewis esophagectomy at our center.

Methods

After IRB approval, we queried our prospectively maintained database for patients who developed an esophageal AL after esophagectomy from August 2016 through July 2022. Data pertaining to demographics, comorbidities, surgical and oncological characteristics, and clinical course were extracted and analyzed.

Results

During the study period, 145 patients underwent an Ivor Lewis esophagectomy; 10 (6.9%) developed an AL, diagnosed a median of 7.5 days after surgery, and detected by enteric contents in wound drains (n = 3), endoscopy (n = 3), CT (n = 2), and contrast esophagogram (n = 2). Nine patients (90%) had an increasing white blood cell count and additional signs of sepsis. One asymptomatic patient was identified by contrast esophagography. All patients received enteral nutritional support, intravenous antibiotics, and antifungals. Primary treatment of ALs included endoscopic placement of a self-expanding metal stent (SEMS; n = 6), surgery (n = 2), and SEMS with endoluminal vacuum therapy (n = 2). One patient required surgery after SEMS placement. The median length of ICU and total hospital stays were 11.5 and 22.5 days, respectively. There was no 30-day mortality.

Conclusion

The incidence of esophageal ALs at our center is similar to that of other high-volume centers. Most ALs can be managed without surgery; however, ALs remain a significant source of postoperative morbidity despite clinical advancements that have improved mortality.

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Acknowledgements

The authors thank Kristine Nally for her excellent editorial assistance and support during the editorial process.

Author information

Authors and Affiliations

  1. Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, 500 W Thomas Road, Phoenix, AZ, 85013, USA

    Andrés R. Latorre-Rodríguez, Jasmine Huang, Lara Schaheen, Michael A. Smith, Samad Hashimi, Ross M. Bremner & Sumeet K. Mittal

  2. Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA

    Jasmine Huang, Lara Schaheen, Michael A. Smith, Samad Hashimi, Ross M. Bremner & Sumeet K. Mittal

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  1. Andrés R. Latorre-Rodríguez
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  2. Jasmine Huang
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  6. Ross M. Bremner
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  7. Sumeet K. Mittal
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Contributions

Study conception and design: Latorre-Rodríguez and Mittal; Acquisition of data: Latorre-Rodríguez, Huang, Schaheen, Smith, Hashimi, Bremner, and Mittal; Analysis and interpretation of data: Latorre-Rodríguez and Mittal; Drafting of manuscript: Latorre-Rodríguez; Critical revision of manuscript: Latorre-Rodríguez, Huang, Schaheen, Smith, Hashimi, Bremner, and Mittal; Approval of the final manuscript: All authors.

Corresponding author

Correspondence to Sumeet K. Mittal.

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Competing interests

The authors declare no competing interests.

Ethics approval and informed consent

The Institutional Review Board of St. Joseph’s Hospital and Medical Center approved the collection and publication of data under the Norton Thoracic Institute Foregut Umbrella Protocol (PHXU-21–500-136–73-18). Written patient consent was waived because of the retrospective design and use of de-identified data.

Conflict of interest

The authors declare no competing interests.

Meeting presentation

Some of his data was presented as a poster at the 2023 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, March 29th to April 1st, 2023 in Montreal, Canada.

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Latorre-Rodríguez, A.R., Huang, J., Schaheen, L. et al. Diagnosis and management of anastomotic leaks after Ivor Lewis esophagectomy: a single-center experience. Langenbecks Arch Surg 408, 397 (2023). https://doi.org/10.1007/s00423-023-03121-x

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