Treatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions

Ubels, Sander; Lubbers, Merel; Verstegen, Moniek; Bouwense, Stefan; Daele, Elke Van; Ferri, Lorenzo; Gisbertz, Suzanne S.; Griffiths, Ewen A.; Grimminger, Peter P.; Hanna, George B.; Hubka, M; Law, Simon; Low, Donald E.; Luyer, Misha; Merritt, Robert E.; Morse, Christopher R.; Mueller, Carmen L.; Nieuwenhuijzen, G.A.P.; Nilsson, Magnus; Reynolds, John V.; Ribeiro, Ulysses; Rosati, Riccardo; Shen, Yaxing; Wijnhoven, Bas P. L.; Workum, Frans van; Rosman, Camiel

doi:10.1093/dote/doac020

Cited by 11 publications

(19 citation statements)

References 39 publications

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“…Our management strategies for anastomotic leak were consistent with those previously reported ( 10 , 11 ). They could be sorted into three levels: conservative management, endoscopic intervention, and reoperation, and which treatment would be performed depended on the symptoms and surgeons’ experience.…”

Section: Methodssupporting

confidence: 87%

Safety of omitting nasogastric decompression after esophagectomy: a propensity score-matched study

Guo,

Shao,

et al. 2023

J Thorac Dis

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Background Nasogastric (NG) decompression is routinely performed after esophagectomy. However, whether it aids postoperative recovery is still controversial. This study aimed to assess the effects of NG decompression on postoperative complications after esophagectomy. Methods Data of 1,489 consecutive patients who underwent esophagectomy between January 2019 and December 2020 were retrospectively analyzed. All patients were assigned to two groups based on whether they had undergone NG decompression or not. We conducted a propensity score matching (PSM) analysis to minimize the effect of potential confounders. Results In total, 1,466 patients (including 1,235 patients with NG tubes and 231 without NG tubes) were included in the study, and 219 pairs were successfully matched. After PSM analysis, there was no difference in morbidity and mortality between the two groups. Postoperative hospital stay in the non-NG tube group was shorter than that in the NG tube group (8 vs. 10 days, P<0.001). The incidence of pneumonia and anastomotic leakage showed no significant differences (13.2% vs. 17.8%, P=0.235 for pneumonia; 13.7% vs. 11.0%, P=0.460 for anastomotic leakage). For patients who developed anastomotic leakage after surgery, the leakage developed earlier in the non-NG group (6 vs. 8 days, P=0.033) than in the NG group. However, no significant between-group differences were observed in the postoperative hospital stay and severity of leakage. Conclusions Routine NG decompression may not confer any discernible benefits for patients who have undergone esophagectomy. As such, the omission of this procedure could be considered in postoperative care.

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Section: Methodssupporting

confidence: 87%

Safety of omitting nasogastric decompression after esophagectomy: a propensity score-matched study

Guo,

Shao,

et al. 2023

J Thorac Dis

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“…There are potential complications associated with the use of central venous catheters for thoracic drainage, including concerns that their smaller diameter may affect postoperative observations such as bleeding, anastomotic leakage, and chylothorax, potentially putting patients at risk [17][18][19] . However, recent research has shown that the modest diameter of central venous catheters generally produces little discomfort following removal, and that the lesion heals quickly.…”

Section: Complicationsmentioning

confidence: 99%

Comparison of Central Venous Catheter Thoracic Drainage with Traditional Closed Thoracic Drainage after Minimally Invasive Surgery for Esophageal Cancer: A Retrospective Study

Zhao

Bai

et al. 2023

Preprint

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Background To compare the effectiveness and safety of central venous catheter thoracic drainage (CVC-TD) with traditional closed thoracic drainage (TCTD) after minimally invasive surgery for esophageal cancer. Methods We conducted a retrospective study of 103 patients who underwent minimally invasive surgery for esophageal cancer at our institution between January 2017 and December 2019. Forty-four patients received CVC-TD, while 59 patients received TCTD. We compared the following outcomes between the two groups: drainage volume, drainage duration, incidence of postoperative complications (including pleural effusion, pneumonia, and atelectasis), length of hospital stays, and overall survival. Results The drainage volume and duration were similar between the two groups. However, the incidence of postoperative complications was significantly lower in the CVC-TD group than in the TCTD group (p < 0.05). The length of hospital stay was also shorter in the CVC-TD group (p < 0.05). There was no significant difference in overall survival between the two groups. Conclusion CVC-TD is a safe and effective alternative to TCTD after minimally invasive surgery for esophageal cancer. It may help reduce the incidence of postoperative complications and shorten the length of hospital stay. Further studies are needed to confirm these findings.

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“…MIE experts, identified through a literature search in the field of MIE and previous research collaborations [ 8 , 26 – 28 ], were contacted to participate in this study. In total, 9 MIE experts who performed at least 120 MIEs [ 24 ] and currently perform at least 50 MIEs annually from Europe (6), the USA (2), and Asia (1) were included.…”

Section: Methodsmentioning

confidence: 99%

Crowd-sourced and expert video assessment in minimally invasive esophagectomy

Ketel,

Klarenbeek,

Eddahchouri

et al. 2023

Surg Endosc

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Background Video-based assessment by experts may structurally measure surgical performance using procedure-specific competency assessment tools (CATs). A CAT for minimally invasive esophagectomy (MIE-CAT) was developed and validated previously. However, surgeon’s time is scarce and video assessment is time-consuming and labor intensive. This study investigated non-procedure-specific assessment of MIE video clips by MIE experts and crowdsourcing, collective surgical performance evaluation by anonymous and untrained laypeople, to assist procedure-specific expert review. Methods Two surgical performance scoring frameworks were used to assess eight MIE videos. First, global performance was assessed with the non-procedure-specific Global Operative Assessment of Laparoscopic Skills (GOALS) of 64 procedural phase-based video clips < 10 min. Each clip was assessed by two MIE experts and > 30 crowd workers. Second, the same experts assessed procedure-specific performance with the MIE-CAT of the corresponding full-length video. Reliability and convergent validity of GOALS for MIE were investigated using hypothesis testing with correlations (experience, blood loss, operative time, and MIE-CAT). Results Less than 75% of hypothesized correlations between GOALS scores and experience of the surgical team (r < 0.3), blood loss (r = − 0.82 to 0.02), operative time (r = − 0.42 to 0.07), and the MIE-CAT scores (r = − 0.04 to 0.76) were met for both crowd workers and experts. Interestingly, experts’ GOALS and MIE-CAT scores correlated strongly (r = 0.40 to 0.79), while crowd workers’ GOALS and experts’ MIE-CAT scores correlations were weak (r = − 0.04 to 0.49). Expert and crowd worker GOALS scores correlated poorly (ICC ≤ 0.42). Conclusion GOALS assessments by crowd workers lacked convergent validity and showed poor reliability. It is likely that MIE is technically too difficult to assess for laypeople. Convergent validity of GOALS assessments by experts could also not be established. GOALS might not be comprehensive enough to assess detailed MIE performance. However, expert’s GOALS and MIE-CAT scores strongly correlated indicating video clip (instead of full-length video) assessments could be useful to shorten assessment time. Graphical abstract

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Treatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions

Cited by 11 publications

References 39 publications

Safety of omitting nasogastric decompression after esophagectomy: a propensity score-matched study

Safety of omitting nasogastric decompression after esophagectomy: a propensity score-matched study

Comparison of Central Venous Catheter Thoracic Drainage with Traditional Closed Thoracic Drainage after Minimally Invasive Surgery for Esophageal Cancer: A Retrospective Study

Crowd-sourced and expert video assessment in minimally invasive esophagectomy

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