The Optimal Treatment Strategy for Postoperative Anastomotic Leakage After Esophagectomy: a Comparative Analysis Between Endoscopic Vacuum Therapy and Conventional Treatment

Joonseok Lee, Jae Hyun Jeon, Seung Hwan Yoon, Beatrice Chia Hui Shih, Woohyun Jung, Yoohwa Hwang, Sukki Cho, Kwhanmien Kim, Sanghoon Jheon

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Abstract

Background: We compared the clinical outcomes between endoscopic vacuum therapy (EVT) and conventional treatment (CT) for the management of post-esophagectomy anastomotic leakage. Methods: A retrospective review of the medical records of patients who underwent esophagectomy with esophagogastrostomy from November 2003 to August 2021 was conducted. Thirty-four patients who developed anastomotic leakage were analyzed according to whether they underwent CT (n = 13) or EVT (n = 21). Results: The median time to complete healing was significantly shorter in the EVT group than in the CT group (16 [4–142] days vs. 70 [8–604] days; p = 0.011). The rate of clinical success was higher in the EVT group (90.5%) than in the CT group (66.7%, p = 0.159). A subgroup analysis showed more favorable outcomes for EVT in patients with thoracic leakage, including a higher clinical success rate (p = 0.037), more rapid complete healing (p = 0.004), and shorter hospital stays (p = 0.006). However, the results were not significantly different in patients with cervical leakage. Anastomotic strictures occurred in 3 EVT patients (14.3%) and 5 CT patients (50.0%) (p = 0.044), and the EVT group showed a trend towards improved freedom from anastomotic strictures (p = 0.105). Conclusions: EVT could be considered as an adequate treatment option for post-esophagectomy anastomotic leakage. EVT might have better clinical outcomes compared to CT for managing anastomotic leakage after transthoracic esophagogastrostomy, and further studies are needed to evaluate the effectiveness of EVT in patients who undergo cervical esophagogastrostomy.

Original languageEnglish
Pages (from-to)2899-2906
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume27
Issue number12
DOIs
StatePublished - Dec 2023

Bibliographical note

Publisher Copyright:
© The Society for Surgery of the Alimentary Tract 2023.

Keywords

  • Anastomotic leak
  • Endoscopic vacuum therapy
  • Esophagectomy

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