Intrathoracic Leaks Following Esophagectomy Are No Longer Associated With Increased Mortality

Abstract

Modern surgical management of intrathoracic leaks results in no increased mortality and has no impact on long-term survival. Clinical decisions regarding the use of intrathoracic anastomoses should not be affected by concerns of increased mortality from leak.

Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy

“…The major predisposing factors are ischemia of the gastric conduit and errors in surgical technique [4]. Unfortunately, the ideal technique for esophageal anastomosis has not been established [5,6] and anastomotic leakage occurs in 3-25% of patients [7][8][9]. Moreover, the associated mortality rate ranges from 5 to 40% [10][11][12], being as high as 60% for intrathoracic anastomoses [1].…”

Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

“…Incidences of anastomotic leakage after esophagectomy range between 0 and 40% [3][4][5], with higher leakage rates after cervical than intrathoracic anastomoses [1,6]. While some authors did not report increased mortality after intrathoracic leakage [7], a large number of studies postulated an elevated leakage-related mortality between 18.2 and 35% [8][9][10][11][12], with a threefold higher risk of mortality after leakage [12]. Furthermore, patients requiring surgical treatment for leakage had worse outcome compared to patients with conservative management [13].…”

Methods of esophagogastric anastomoses following esophagectomy for cancer: A systematic review

“…Early complications involving the esophagogastric anastomosis, such as an anastomotic leak, are responsible for significant morbidity and mortality following surgery [8,9]. Leak rates in recent literature range from 0% to 24% [10][11][12][13][14][15] and anastomotic leaks are among the main causes of postoperative mortality, estimated to be responsible for up to 90% of deaths following esophagectomy [16][17][18][19]. Late complications, such as anastomotic stricture, are also responsible for significant morbidity.…”