TY - JOUR
T1 - The Optimal Treatment Strategy for Postoperative Anastomotic Leakage After Esophagectomy
T2 - a Comparative Analysis Between Endoscopic Vacuum Therapy and Conventional Treatment
AU - Lee, Joonseok
AU - Jeon, Jae Hyun
AU - Yoon, Seung Hwan
AU - Shih, Beatrice Chia Hui
AU - Jung, Woohyun
AU - Hwang, Yoohwa
AU - Cho, Sukki
AU - Kim, Kwhanmien
AU - Jheon, Sanghoon
N1 - Publisher Copyright:
© The Society for Surgery of the Alimentary Tract 2023.
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - Anastomotic leak
KW - Endoscopic vacuum therapy
KW - Esophagectomy
UR - http://www.scopus.com/inward/record.url?scp=85178214309&partnerID=8YFLogxK
U2 - 10.1007/s11605-023-05637-5
DO - 10.1007/s11605-023-05637-5
M3 - Article
C2 - 38040922
AN - SCOPUS:85178214309
SN - 1091-255X
VL - 27
SP - 2899
EP - 2906
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 12
ER -