title: Stent placement in the management of oesophageal leaks.
abstract: OBJECTIVE
  To examine retrospectively the patients of our department who had a self-expandable totally covered metal stent placed for oesophageal leak.
  
  
  METHODS
  Patients hospitalised in our department for oesophageal cancer and/or oesophageal perforation between 2004 and 2006. All medical records were retrospectively reviewed. Seventy-two patients underwent oesophageal resection for oesophageal cancer and 16 were managed for oesophageal perforations.
  
  
  RESULTS
  Eight out of 72 patients submitted to resection for oesophageal cancer had postoperative leaks, while one patient developed tracheo-oesophageal fistula (TEF) due to prolonged mechanical ventilation. Six of them had stent placement in first intention, whereas two received the procedure after an unsuccessful repeat operation. The mean stent placement time was 18.4 days (SD=15.2 days), whereas the median was 14 days. The leak was managed efficiently by the stent in seven patients, whereas two patients needed repeat operations (one with TEF). The mean stent removal time was 56.8 days (SD=30.5 days) and the median was 40 days. None developed anastomotic stricture. On the other hand, three out of 16 patients with perforation had a stent, two of them for Boerhaave syndrome and one for iatrogenic rupture after bariatric surgery. One of them required the stent 17 days after surgical repair with excellent results, while the other two patients had the stent placed immediately, but still needed thoracotomy to control the leak.
  
  
  CONCLUSIONS
  Stent placement can prove very useful in the management of post-oesophagectomy anastomotic leaks, but its contribution needs to be evaluated with caution in cases of oesophageal perforations or TEF. Larger series and prospective comparative clinical trials could eventually clarify the role of stents in clinical practice of surgical patients.
authors.affiliation: University of the Mediterranean, Assistance Publique, Hôpitaux de Marseille, Marseille, France. chzisis@hol.gr
authors.forename: Charalambos
authors.initials: C
authors.lastname: Zisis
authors.forename: Alexandra
authors.initials: A
authors.lastname: Guillin
authors.forename: Laurent
authors.initials: L
authors.lastname: Heyries
authors.forename: Pascal
authors.initials: P
authors.lastname: Lienne
authors.forename: Xavier-Benoit
authors.initials: XB
authors.lastname: D'Journo
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Roger
authors.initials: R
authors.lastname: Giudicelli
authors.forename: Pascal-Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D004939:Esophageal Perforation / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis