Stent placement in the management of oesophageal leaks.
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.
Zisis
Charalambos
C
University of the Mediterranean, Assistance Publique, Hôpitaux de Marseille, Marseille, France. chzisis@hol.gr
Guillin
Alexandra
A
Heyries
Laurent
L
Lienne
Pascal
P
D'Journo
Xavier-Benoit
XB
Doddoli
Christophe
C
Giudicelli
Roger
R
Thomas
Pascal-Alexandre
PA
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