Endoscopic vacuum therapy significantly improves clinical outcomes of anastomotic leakages after 2-stage, 3-stage, and transhiatal esophagectomies

Abstract

Background Anastomotic leakages after esophagectomies continue to constitute significant morbidity and mortality. Intrathoracic anastomoses pose a high risk for mediastinitis, sepsis, and death, if a leak is not addressed timely and appropriately. However, there are no standardized treatment recommendations or algorithms as for how to treat these leakages. Methods The study included all patients at the University Hospital Regensburg, who developed an anastomotic leakage after esophagectomy with gastric pull-up reconstruction from 2007 to 2022. Patients receiving conventional treatment options for an anastomotic leakage (stents, drainage tubes, clips, etc.) were compared to patients receiving endoscopic vacuum-assisted closure (eVAC) therapy as their mainstay of treatment. Treatment failure was defined as cervical esophagostomy formation or death. Results In total, 37 patients developed an anastomotic leakage after esophagectomy with a gastric pull-up reconstruction. Twenty patients were included into the non-eVAC cohort, whereas 17 patients were treated with eVAC. Treatment failure was observed in 50% of patients (n = 10) in the non-eVAC cohort and in 6% of patients (n = 1) in the eVAC cohort (p < 0.05). The 90-day mortality in the non-eVAC cohort was 15% (n = 3) compared to 6% (n = 1) in the eVAC cohort. Cervical esophagostomy formation was required in 40% of cases (n = 8) in the non-eVAC cohort, whereas no patient in the eVAC cohort underwent cervical esophagostomy formation. Conclusion eVAC therapy for leaking esophagogastric anastomoses appears to be superior to other treatment strategies as it significantly reduces morbidity and mortality. Therefore, we suggest eVAC as an essential component in the treatment algorithm for anastomotic leakages following esophagectomies, especially in patients with intrathoracic anastomoses.

Oesophagopleural fistula after pneumonectomy: A systematic review and case series

“…Although in recent years the treatment of anastomotic leaks and oesophageal perforation has shown promising results with endoluminal vacuum treatment techniques, this has not been specifically reported in OPF post pneumonectomy. 24 , 25 Gabryel et al used it successfully in a patient with a bronchial fistula and oesophageal leak after a combined lobectomy and oesophagetomy. 26 Theoretically, it might not work in OPF alone because endoscopic vacuum treatment relies on healing of the perforation by collapse of the associated cavity with the formation of granulation tissue and then scar tissue.…”

Factors Influencing Postoperative Complications Following Minimally Invasive Ivor Lewis Esophagectomy: A Retrospective Cohort Study

“…This approach contrasts with the standard procedure, where the EndoVac is used only in case of complications [22]. The EndoVac is a standard therapy for postoperative treatment [23][24][25]. The pre-emptive EndoVac therapy is a novel technology for reducing AI rate and postoperative morbidity.…”