Abstract
Background
In patients with esophagectomy and gastric pull up for esophageal carcinoma anastomotic leaks are a well-known complication and a major cause of morbidity and mortality.
Objective
We evaluated stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy.
Methods
269 patients with esophageal cancer (adenocarcinoma n = 212, squamous cell carcinoma n = 57) had undergone esophagectomy and gastric pull up with an intrathoracic anastomosis between January 1998 and December 2005. A thoracic anastomotic leak was clinically and endoscopically proven in 12 patients (4.5%). Endoscopic insertion of a self-expanding covered metal stent at the site of the anastomotic leak was performed in 10 patients; two patients were treated with fibrin glue.
Results
Stents were successfully placed in all patients without complications. In all but one patient (n = 9) radiological examination showed complete closure of the leakage. In one patient the stent was endoscopically corrected and complete closure could be achieved thereafter. The stent could be removed after six weeks in five patients. Stent migration occurred in four patients. In all but one patient (n = 7) definitive leak occlusion was achieved. Two patients died during their hospital stayfor reasons not related to the stent placement.
Conclusion
Stent implantation in patients with thoracic anastomotic leaks after esophagectomy is an easily available and effective treatment option with low morbidity, but stent migration does occur.
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References
Alanezi K, Urschel JD (2004) Mortality secondary to esophageal anastomotic leaks. Ann Thorac Cardiovasc 10:71–75
Hölscher AH, Schröder W, Bollschweiler E, Beckurts KT, Schneider PM (2003) Wie sicher ist die hohe intrathorakale Ösophagogastrostomie? Chirurg 74:726–733
Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:634–640
Griffin SM, Lamb PJ, Dresner SM, Richardson DL, Hayes N (2001) Diagnosis and management of mediastinal leak following radical oesophagectomy. Br J Surg 88:1346–1351
Boyle MJ, Franceschi D, Livingston AS (1999) Transhiatal versus transthoracic esophagectomy: complication and survival rates. Am Surg 65:1137–1141
Siewert JR, Stein HJ, Bartels H (2004) Insuffizienzen nach Anastomosen im Bereich des oberen Gastrointestinaltraktes. Chirurg 75:1063–1070
Siewert JR, Feith M, Werner M, Stein HJ (2000) Adenocarcinoma of the esophagogastric junction. Ann Surg 232:353–361
Blewett CJ, Miller JD, Young JE, et al. (2001) Anastomotic leaks after esophagectomy for esophageal cancer: a comparison of thoracic and cervical anastomoses. Ann Thorac Cardiovasc Surg 7:75–78
Siewert JR, Hölscher AH, Becker K, Gossner W (1987) Cardia cancer: attempt at a therapeutically relevant classification. Chirurg 58:25–34
Schmidt H, Manegold BC, Stuker D, Grund KE (2001) Anastomotic insufficiences of the esophagus – early surgical endoscopy and endoscopic therapy. Kongressbd Dtsch Ges Chir Kongr 118:278–281
Sarper A, Oz N, Cihangir C, Demirzan A, Isin E (2003) The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg 23 (5):794–798
Homs MY, Steyerberg EW, Kuipers EJ, van der Gaast A, Haringsma J, van Blankenstein M, Siermsa PD (2004) Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma. Endoscopy 36(10):880–886
Elphick DA, Smith BA, Bagshaw J, Riley SA (2005) Self-expanding metal stents in the palliation of malignant dysphagia: outcome analysis in 100 consecutive patients. Dis Esophagus 18(2):93–95
Christie NA, Buenaventura PO, Fernando HC, Nguyen NT, Weigel TL, Ferson PF, Luketich JD (2001) Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg 71(6):1797–1802
Radecke K, Gerken G, Treichel U (2005) Impact of self-expanding, plastic esophageal stent on various esophageal stenosis, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc 61(7):812–818
Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H (2003) Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy 35:652–658
Hünerbein M, Stroszczynski C, Moesta K, Schlag P (2004) Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 240(5):801–807
Costamagna G, Shah SK, Tringali A, Mutignani M, Perri V, Riccioni ME (2003) Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures. Surg Endosc 17:891–895
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Kauer, W.K.H., Stein, H.J., Dittler, HJ. et al. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc 22, 50–53 (2008). https://doi.org/10.1007/s00464-007-9504-5
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DOI: https://doi.org/10.1007/s00464-007-9504-5