In the short term, LVR using biological mesh is safe and as effective as synthetic mesh, with high patient satisfaction. Constipation and faecal incontinence scores were both improved.

Background. Esophagectomy is a technically demanding procedure associated with high levels of morbidity. Anastomotic leak (AL) is a common complication with potentially major ramifications for patients. It has also been associated with poorer long-term overall survival (OS) and disease recurrence. Objective. The aim of this study was to determine whether AL contributes to poor OS and recurrence-free survival (RFS) for patients with esophageal cancer. Methods. Consecutive patients undergoing a two-stage, two-field transthoracic esophagectomy from a single highvolume unit between 1997 and 2016 were evaluated. Clinicopathologic characteristics, along with oncological and postoperative outcomes, were stratified by no AL versus non-severe leak (NSL) versus severe esophageal AL (SEAL). SEAL was defined as ALs associated with Clavien-Dindo grade III/IV complications. Results. This study included 1063 patients, of whom 8% (87/1063) developed AL; 45% of those who developed AL were SEALs (39/87). SEAL was associated with a prolonged critical care stay (median 8 vs. 3 vs. 2 days; p \ 0.001) and prolonged hospital stay (median 43 vs. 27 vs. 15 days; p \ 0.001) compared with NSL or no AL. There were no significant differences in number of lymph nodes harvested and rates of R1 resection between groups. OS and RFS were not affected by either NSL or SEAL, and Cox multivariate regression showed NSL and SEAL were not independently associated with OS and RFS. Sensitivity analysis in patients receiving neoadjuvant therapy followed by esophagectomy demonstrated similar findings. Conclusion. These results demonstrate that AL leads to prolonged critical care and in-hospital length of stay; however, contrary to previous reports, our results do not compromise long-term outcomes and are unlikely to have a detrimental oncological impact. Esophagectomy remains a key component of treatment for patients with potentially curable esophageal cancer. While mortality levels from the procedure have fallen dramatically over the last 30 years, esophagectomy is still associated with high levels of morbidity. 1-3 Anastomotic leak (AL) is a commonly seen complication that has historically been associated with high mortality rates. 4 The Esophagectomy Complications Consensus Group (ECCG) defined AL as a full-thickness defect involving the esophagus, anastomosis, staple line or conduit, irrespective of the presentation or method of identification. 5 The classification further divided leaks into the management strategy employed: type I, those that require no change in treatment; type II, leaks that require intervention, but not surgery; and type III, leaks that require surgical intervention. The incidence of AL has been reported at between 3 and 30%. 6,7 This can result in a prolonged hospital stay, a need for reoperation, anastomotic stricturing that requires repeated dilations, and potentially poorer long-term survival. 8,9 A French multicenter study, which defined severe

Background: Oesophageal perforations are associated with high mortality and morbidity rates. A spectrum of aetiologies and clinical presentations has resulted in a variety of operative and non-operative management strategies. This analysis focused on the impact of these strategies in a single specialist centre.Methods: All patients with oesophageal perforation managed in a single oesophagogastric unit in the UK between January 2002 and December 2012 were identified. Gastric perforations and anastomotic leaks were excluded. Data were verified using an endoscopy database, electronic and paper records. Aetiology of perforation, management and outcomes were analysed.Results: There were 101 adult patients with oesophageal perforation. Complete records were not available for five patients and they were excluded from the analysis. The median age was 69·5 years. Thoracic perforations were present in 84 per cent of patients. There were 51 spontaneous perforations, 41 iatrogenic and four related to foreign bodies. Oesophageal malignancy was present in 11 patients. Forty-four patients were managed surgically, 47 without operation and five patients were considered unfit for active treatment. The in-hospital mortality rate for treated patients was 24 per cent and median length of hospital stay was 31·5 days. Conclusion:The management of oesophageal perforation requires specialist multidisciplinary input. It is best provided in an environment familiar with the range of treatment modalities. Management decisions should be guided primarily by the degree of contamination rather than the aetiology of the defect. The routine use of stents is unproven and controversial.

Leaks can be managed with excellent outcomes without using oesophageal stents. The results do not support the widespread adoption of endoscopic stenting.