Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2019

Open Access 01-12-2019 | Esophageal Cancer | Review

Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review

Authors: Moniek H. P. Verstegen, Stefan A. W. Bouwense, Frans van Workum, Richard ten Broek, Peter D. Siersema, Maroeska Rovers, Camiel Rosman

Published in: World Journal of Emergency Surgery | Issue 1/2019

Login to get access

Abstract

Background

Anastomotic leakage (0–30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy have the best clinical outcome, based on the currently available literature.

Methods

A systematic literature search was performed in Medline, Embase, and Web of Science until April 2017. All studies reporting on the specific treatment of cervical or intrathoracic anastomotic leakage following esophagectomy with gastric tube reconstruction for esophageal or cardia cancer were included. The primary outcome parameter was postoperative mortality. Methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale.

Results

Nineteen retrospective cohort studies including 273 patients were identified. Methodological quality of all studies was poor to moderate. Mortality rates of intrathoracic anastomotic leakages in the treatment groups were as follows: conservative (14%), endoscopic stent (8%), endoscopic drainage (8%), endoscopic vacuum-assisted closure system (0%), and surgery treatment group (50%). Mortality rates of cervical anastomotic leakages in the treatment groups were as follows: conservative (8%), endoscopic stent (29%), and endoscopic dilatation (0%).

Discussion

Due to small cohorts, heterogeneity between studies, and lack of data regarding leakage characteristics, no evidence supporting a specific treatment for anastomotic leakage after esophagectomy was found. A severity score based on leakage characteristics instead of treatment given is essential for determining the optimal treatment of anastomotic leakage. In the absence of robust evidence-based treatment guidelines, we suggest customized treatment depending on sequelae of the leak and clinical condition of the patient. PrDepartment of Surgery, Radboudumc, P.O.B. 9101/618 NLactical advices are provided.

Trial registration

Registration number PROSPERO: CRD42016032374.
Appendix
Available only for authorised users
Literature
1.
Dikken JL, Lemmens VE, Wouters MW, Wijnhoven BP, Siersema PD, Nieuwenhuijzen GA, van Sandick JW, Cats A, Verheij M, Coebergh JW, van de Velde CJ. Increased incidence and survival for oesophageal cancer but not for gastric cardia cancer in the Netherlands. Eur J Cancer. 2012;48(11):1624–32.PubMedCrossRef
2.
Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381(9864):400–12.PubMedCrossRef
3.
4.
Biere SS, Maas KW, Cuesta MA, van der Peet DL. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg. 2011;28(1):29–35.PubMedCrossRef
5.
Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg. 2004;10(2):71–5.PubMed
6.
Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256(1):95–103.PubMedPubMedCentralCrossRef
7.
van Heijl M, Gooszen JA, Fockens P, Busch OR, van Lanschot JJ, van Berge Henegouwen MI. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg. 2010;251(6):1064–9.PubMedCrossRef
8.
Blackmon SH, Correa AM, Wynn B, Hofstetter WL, Martin LW, Mehran R, Rice DC, Swiser SG, Walsh GL, Roth JA, Vaporiyan AA. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg. 2007;83(5):1805–13 discussion 13.PubMedCrossRef
9.
Martin LW, Hofstetter W, Swisher SG, Roth JA. Management of intrathoracic leaks following esophagectomy. Adv Surg. 2006;40:173–90.PubMedCrossRef
10.
Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg. 2014;208(4):536–43.PubMedPubMedCentralCrossRef
11.
12.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.PubMedCrossRef
13.
14.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedPubMedCentralCrossRef
15.
Al-issa MA, Petersen TI, Taha AY, Shehatha JS. The role of esophageal stent placement in the management of postesophagectomy anastomotic leak. Saudi J Gastroenterol. 2014;20(1):39–42.PubMedPubMedCentralCrossRef
16.
Bhasin DK, Sharma BC, Gupta NM, Sinha SK, Singh K. Endoscopic dilation for treatment of anastomotic leaks following transhiatal esophagectomy. Endoscopy. 2000;32(6):469–71.PubMedCrossRef
17.
Bludau M, Holscher AH, Herbold T, Leers JM, Gutschow C, Fuchs H, Schröder W. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc. 2014;28(3):896–901.PubMedCrossRef
18.
Griffin SM, Lamb PJ, Dresner SM, Richardson DL, Hayes N. Diagnosis and management of a mediastinal leak following radical oesophagectomy. Brit J Surg. 2001;88(10):1346–51.PubMedCrossRef
19.
Holscher AH, Schroder W, Bollschweiler E, Beckurts KT, Schneider PM. How safe is high intrathoracic esophagogastrostomy? Chirurg. 2003;74(8):726–33.PubMedCrossRef
20.
Hu Z, Yin R, Fan X, Zhang Q, Feng C, Yuan F, Chen J, Jiang F, Li N, Xu L. Treatment of intrathoracic anastomotic leak by nose fistula tube drainage after esophagectomy for cancer. Dis Esophagus. 2011;24(2):100–7.PubMedCrossRef
21.
Hunerbein M, Stroszczynski C, Moesta KT, Schlag PM. Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg. 2004;240(5):801–7.PubMedPubMedCentralCrossRef
22.
Jiang F, Yu MF, Ren BH, Yin GW, Zhang Q, Xu L. Nasogastric placement of sump tube through the leak for the treatment of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. J Surg Res. 2011;171(2):448–51.PubMedCrossRef
23.
Kauer WK, Stein HJ, Dittler HJ, Siewert JR. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc. 2008;22(1):50–3.PubMedCrossRef
24.
Korst RJ, Port JL, Lee PC, Altorki NK. Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma. Ann Thorac Surg. 2005;80(4):1185–90.PubMedCrossRef
25.
Larburu Etxaniz S, Gonzales Reyna J, Elorza Orue JL, Asensio Gallego JI, Diez del Val I, Eizaguirre Letamendia E, Mar Medina B. Cervical anastomotic leak after esophagectomy: diagnosis and management. Cir Esp. 2013;91(1):31–7.PubMedCrossRef
26.
Leenders BJ, Stronkhorst A, Smulders FJ, Nieuwenhuijzen GA, Gilissen LP. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27(8):2751–9.PubMedCrossRef
27.
Lindenmann J, Matzi V, Porubsky C, Anegg U, Sankin O, Gabor S, Neuboeck N, Maier A, Smolle-Juettner FM. Self-expandable covered metal tracheal type stent for sealing cervical anastomotic leak after esophagectomy and gastric pull-up: pitfalls and possibilities. Ann Thorac Surg. 2008;85(1):354–6.PubMedCrossRef
28.
Orringer MB, Lemmer JH. Early dilation in the treatment of esophageal disruption. Ann Thorac Surg. 1986;42(5):536–9.PubMedCrossRef
29.
Qin J, Li Y, Zhang R, Yan M, Wang G, Liu B. Treatment of esophagogastric anastomotic leak with perianastomotic drain. J Thorac Oncol. 2010;5(2):251–3.PubMedCrossRef
30.
Shuto K, Kono T, Akutsu Y, Uesato M, Mori M, Matsuo K, Kosugi C, Hirano A, Tanaka K, Okazumi S, Koda K, Matsubara H. Naso-esophageal extraluminal drainage for postoperative anastomotic leak after thoracic esophagectomy for patients with esophageal cancer. Dis Esophagus. 2017;30(3):1–9.PubMed
31.
Tuebergen D, Rijcken E, Mennigen R, Hopkins AM, Senninger N, Bruewer M. Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg. 2008;12(7):1168–76.PubMedCrossRef
32.
van Rossum PS, Haverkamp L, Carvello M, Ruurda JP, van Hillegersberg R. Management and outcome of cervical versus intrathoracic manifestation of cervical anastomotic leakage after transthoracic esophagectomy for cancer. Dis Esophagus. 2017;30(1):1–8.PubMed
33.
Yin G, Xu Q, Chen S, Bai X, Jiang F, Zhang Q, Xu L, Xu W. Fluoroscopically guided three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage. Korean J Radiol. 2012;13(2):182–8.PubMedPubMedCentralCrossRef
34.
Gooszen JAH, Goense L, Gisbertz SS, Ruurda JP, van Hillegersberg R, van Berge Henegouwen MI. Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer. Br J Surg. 2018;105(5):552–60.PubMedPubMedCentralCrossRef
35.
Messager M, Warlaumont M, Renaud F, Marin H, Branche J, Piessen G, Mariette C. Recent improvements in the management of esophageal anastomotic leak after surgery for cancer. Eur J Surg Oncol. 2017;43(2):258–69.PubMedCrossRef
36.
Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D’Journo XB, Griffin SM, Hölscher AH, Hofstetter WL, Jobe BA, Kitagawa Y, Kucharczuk JC, Law SY, Lerut TE, Maynard N, Pera M, Peters JH, Pramesh CS, Reynolds JV, Smithers BM, van Lanschot JJ. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg. 2015;262(2):286–9.PubMedCrossRef
37.
Metadata
Title
Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review
Authors
Moniek H. P. Verstegen
Stefan A. W. Bouwense
Frans van Workum
Richard ten Broek
Peter D. Siersema
Maroeska Rovers
Camiel Rosman
Publication date
01-12-2019
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2019
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-019-0235-4

Other articles of this Issue 1/2019

World Journal of Emergency Surgery 1/2019 Go to the issue

Research article

Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O)

Case report

At the heart of organ donation. Case reports of organ donation after cardiac death in two patients with successfully repaired AAST grade V cardiac injuries

Research article

Educational value of surgical videos on YouTube: quality assessment of laparoscopic appendectomy videos by senior surgeons vs. novice trainees

Review

Optimal management of malignant left-sided large bowel obstruction: do international guidelines agree?

Research article

Cost-effectiveness of the prevention of adhesions and adhesive small bowel obstruction after colorectal surgery with adhesion barriers: a modelling study

Research article

Global surgery for paediatric casualties in armed conflict