Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer.
BACKGROUND
Leakage from esophageal anastomoses is higher than that for other gastrointestinal anastomoses. An intrathoracic anastomotic leak is a potentially catastrophic event.


METHODS
Patients with and without thoracic anastomotic leakage were compared for predisposing factors. Leak-related mortality was analyzed.


RESULTS
Of 475 patients, there were 17 leaks (3.5%). Predisposing technical factors occurred significantly more frequently in patients who leaked. Sixteen such events were identified as contributory in 11 patients. The hospital mortality for patients who leaked was significantly higher (35% versus 9%, P = 0.005). Inadequate drainage and persistent sepsis accounted for 4 of the 6 deaths. The need for inotropic support postoperatively correlated with leak-related mortality (66% versus 0%, P = 0.006), while leak size, time to diagnosis, or method of drainage did not.


CONCLUSIONS
Thoracic anastomotic leaks are largely preventable. Leak-related mortality for the series was 1% and was most commonly related to inadequate drainage.
Whooley
B P
BP
Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, People's Republic of China.
Law
S
S
Alexandrou
A
A
Murthy
S C
SC
Wong
J
J
D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D016009:Chi-Square Distribution; D004322:Drainage; D004935:Esophageal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome