One Decade of Experience with Endoscopic Stenting for Intrathoracic Anastomotic Leakage after Esophagectomy: Brilliant Breakthrough or Flash in the Pan?

Abstract

Management of intrathoracic anastomotic leakage after esophagectomy by means of endoscopic stent insertion has gained wide acceptance as an alternative to surgical reintervention. Between January 2004 and March 2013 all patients who underwent esophagectomy at a German high-volume center for esophageal surgery were included in this retrospective study. The study comprises 356 patients. Anastomotic leakage occurred in 49 cases. There were no significant differences in age, American Society of Anesthesiologists (ASA) score, or frequency of neoadjuvant therapy between cases with and without leak. However, leak patients sustained significantly more often postoperative pneumonia, pleural empyema, sepsis, and acute renal failure. Moreover, leak victims had higher odds for fatal outcome (16 of 49 vs 33 of 307; odds ratio, 5.94; 95% confidence interval, 2.65 to 13.15; P < 0.0001). The leakage was amendable by endoscopic stenting in 29 cases, whereas rethoracotomy was mandatory in 20 patients. Between stent and rethoracotomy cases, we observed no significant differences in age, ASA score, neoadjuvant therapy, occurrence of pneumonia, pleural empyema, or tracheostomy rate. Rethoracotomy patients sustained more often sepsis (16 of 20 vs 14 of 29; P = 0.04) and acute renal failure (nine of 20 vs four of 29; P = 0.02) as expression of more severe septic disease. Nevertheless, there was no significant difference in mortality (seven of 29 vs nine of 20; P = 0.21). Furthermore, we observed three cases of stent-related aortic erosion with peracute death from exsanguination. Despite being the preferred treatment option, endoscopic stenting was only feasible in approximately 60 per cent of all intrathoracic leaks. The results are marred by the occurrence of deadly vascular erosion. Therefore, individualized strategies should be preferred to a general recommendation for endoscopic stenting.

Efficacy and analysis of modified “three-tube method” in the treatment of intrathoracic anastomotic leakage after esophagectomy

“…In addition, serious complications related to SEMS have also been reported (9,10,12). Schweigert et al (13,14) reported that 29 patients underwent SEMS after being diagnosed with anastomotic leakage, and the results showed a high incidence of stent-related complications. Among the 29 patients, 3 (10.3%) had aortic erosion, 1 (3.4%) had intestinal bleeding due to stent displacement, and 1 (3.4%) had airway obstruction.…”

The Role of Endoscopic Stent in Management of Postesophagectomy Leaks

“…Mortality rates of anastomotic leaks have been reported as high as 25-45%. [10][11][12][13] Our approach to the management of postoperative leak has evolved since we began performing MIE in 1998. Conventional management consisted of reoperative thoracotomy with possible gastrointestinal diversion, which is an invasive life-saving operation that requires gastrointestinal reconstruction at a later date.…”

Variations in treatment of an anastomotic leakage after Ivor Lewis Esophagectomy

“…Anastomotic Leakage (AL) is still a feared and life-threatening complication after Ivor Lewis Esophagectomy (ILE) with reported incidence rates of 5-25% and mortality rates up to 20-40 [1][2][3][4][5]. The classification of the Esophagectomy Complications Consensus Group (ECCG) has been introduced to differentiate between different types of AL [6].…”