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Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study

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Abstract

Background

Anastomotic leakage after esophagectomy is a life-threatening complication. No comparative outcome analyses for the different treatment regimens are yet available.

Methods

In a single-center study, data from all esophagectomy patients from January 1995 to January 2012, including tumor characteristics, surgical procedure, postoperative anastomotic leakage, leakage therapy regimens, APACHE II scores, and mortality, were collected, and predictors of patient survival after anastomotic leakage were analyzed.

Results

Among 366 resected patients, 62 patients (16 %) developed an anastomotic leak, 16 (26 %) of whom died. Therapy regimens included surgical revision (n = 18), endoscopic endoluminal vacuum therapy (n = 17), endoscopic stent application (n = 12), and conservative management (n = 15). APACHE II score at the initiation of treatment for leakage was the strongest predictor of in-hospital mortality (p < 0.0017). Conservatively managed patients showed mild systemic illness (mean APACHE II score 5) and no mortality. In systemically ill patients matched for APACHE II scores (mean, 14.4), endoscopic endoluminal vacuum therapy patients had lower mortality (12 %) compared to surgically treated (50 %, p = 0.01) cases and patients managed by stent placement (83 %, p = 00014, log rank test). No other clinical or laboratory parameters significantly influenced patient survival.

Conclusions

Endoscopic endoluminal vacuum therapy was the best treatment of anastomotic leakage in systemically ill patients after esophagectomy in this retrospective analysis. It should therefore be considered an important instrument in the management of this disorder.

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Acknowledgments

Supported in part by institutional funding of the University of Kiel.

Disclosures

The investigators Bodo Schniewind and Clemens Schafmayer are working with B. Braun Melsungen on the development of a follow-up device for endoluminal vacuum therapy. Gesa Voehrs, Jan Egberts, Witigo von Schoenfels, Tobias Rose, Roland Kurdow, Alexander Arlt, Mark Ellrichmann, Christian Jürgensen, Stefan Schreiber, Thomas Becker, and Jochen Hampe have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General and Thoracic Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (Haus 18), 24105, Kiel, Germany

    Bodo Schniewind, Clemens Schafmayer, Gesa Voehrs, Jan Egberts, Witigo von Schoenfels, Tobias Rose, Roland Kurdow & Thomas Becker

  2. Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (Haus 6), 24105, Kiel, Germany

    Alexander Arlt, Mark Ellrichmann, Stefan Schreiber & Jochen Hampe

  3. Department of Gastroenterology, Rheumatology and Infectious Diseases, Charité University Hospital, Berlin, Germany

    Christian Jürgensen

Authors
  1. Bodo Schniewind
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  2. Clemens Schafmayer
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  8. Alexander Arlt
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  11. Stefan Schreiber
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  12. Thomas Becker
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  13. Jochen Hampe
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Correspondence to Bodo Schniewind.

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Schniewind, B., Schafmayer, C., Voehrs, G. et al. Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study. Surg Endosc 27, 3883–3890 (2013). https://doi.org/10.1007/s00464-013-2998-0

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  • DOI: https://doi.org/10.1007/s00464-013-2998-0

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