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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2014

01-08-2014 | Gastrointestinal Oncology

Routine Contrast Esophagram has Minimal Impact on the Postoperative Management of Patients Undergoing Esophagectomy for Esophageal Cancer

Authors: Jonathan Cools-Lartigue, MD, Amin Andalib, MD, Ali Abo-Alsaud, MD, Stephen Gowing, MD, Maxime Nguyen, MD, David Mulder, MD, Lorenzo Ferri, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2014

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Abstract

Background

Routine contrast esophagram is frequently performed after esophagectomy in order to detect occult anastomotic leak (AL). This modality has a low sensitivity, and its routine use has been called into question. Accordingly, we sought to demonstrate the clinical impact of routine contrast esophagography in the management of patients undergoing esophagectomy for malignant disease.

Methods

All patients undergoing esophagectomy from 2005 to 2011 for malignancy at a North American University hospital were identified from a prospectively collected database. Barium esophagram (BE) was performed within the first week postoperatively. Patients were dichotomized according to whether they had an AL, and the sensitivity and specificity of BE was determined. The clinical impact of the BE result, defined as cessation of enteral feeding, additional interventions, or delay in discharge, was determined.

Results

Overall, 221 patients underwent esophagectomy. Thirty (13.6 %) developed an AL, of which 10 (30 %) had a positive BE, 12 (40 %) had a negative BE, and 8 (26.7 %) had no BE and were diagnosed clinically (1/8), by computed tomography (CT) (3/8), endoscopically (3/8), or at reoperation (1/7). AL in patients with a negative BE was confirmed clinically (4/12), by CT (6/12), endoscopically (1/12), or at reoperation (1/12). The sensitivity and specificity of BE was 45.5 and 97.8 %, respectively. BE altered postoperative management in 8/221 (3.6 %) patients, with 5/221 (2.3 %) undergoing therapeutic intervention. Conversely, 3/221 (1.4 %) patients demonstrated clinically insignificant AL, delaying discharge and feeding without intervention.

Conclusion

Contrast esophagram is not an effective screening modality for AL when employed routinely following esophagectomy.
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Metadata
Title
Routine Contrast Esophagram has Minimal Impact on the Postoperative Management of Patients Undergoing Esophagectomy for Esophageal Cancer
Authors
Jonathan Cools-Lartigue, MD
Amin Andalib, MD
Ali Abo-Alsaud, MD
Stephen Gowing, MD
Maxime Nguyen, MD
David Mulder, MD
Lorenzo Ferri, MD, PhD
Publication date
01-08-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 8/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3654-1

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