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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2016

01-11-2016

Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series

Authors: Jean-Michel Gonzalez, C. Servajean, B. Aider, M. Gasmi, X. B. D’Journo, M. Leone, J. C. Grimaud, M. Barthet

Published in: Surgical Endoscopy | Issue 11/2016

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Abstract

Background and aims

Anastomotic leakages are severe and often lethal adverse events of surgery for esophageal cancer. The endoscopic treatment is growing up in such indications. The aim was to evaluate the efficacy and describe the strategy of the endoscopic management of anastomotic leakages/fistulas after esophageal oncologic surgery.

Methods

Single-center retrospective study on 126 patients operated for esophageal carcinomas between 2010 and 2014. Thirty-five patients with postoperative fistulas/leakages (27 %) were endoscopically managed and included. The primary endpoint was the efficacy of the endoscopic treatment. The secondary endpoints were: delays between surgery, diagnosis, endoscopy and recovery; number of procedures; material used; and adverse events rate. Uni- and multivariate analyses were carried out to determine predictive factors of success.

Results

There were mostly men, with a median age of 61.7 years ± 8.9 [43–85]. 48.6 % underwent Lewis-Santy surgery and 45.7 % Akiyama’s. 71.4 % patients received neo-adjuvant chemo-radiation therapy. The primary and secondary efficacy was 48.6 and 68.6 %, respectively. The delay between surgery and endoscopy was 8.5 days [6.00–18.25]. Eighty-eight percentages of the patients were treated using double-type metallic stents, with removability and migration rates of 100 and 18 %, respectively. In the other cases, we used over-the-scope clips, naso-cystic drain or combined approach. The mean number of endoscopy was 2.6 ± 1.57 [1–10]. The mortality rate was 17 %, none being related to procedures. No predictive factor of efficacy could be identified.

Conclusions

The endoscopic management of leakages or fistulas after esophageal surgery reached an efficacy rate of 68.8 %, mostly using stents, without significant adverse events. The mortality rate could be decreased from 40–100 to 17 %.
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Metadata
Title
Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series
Authors
Jean-Michel Gonzalez
C. Servajean
B. Aider
M. Gasmi
X. B. D’Journo
M. Leone
J. C. Grimaud
M. Barthet
Publication date
01-11-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-4828-7

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