Intrathoracic manifestations of cervical anastomotic leaks after transhiatal and transthoracic oesophagectomy.
BACKGROUND
A possible advantage of cervical oesophagogastrostomy over intrathoracic anastomosis after oesophagectomy is the presumed mild clinical course of cervical anastomotic leakage. The incidence and consequences of intrathoracic manifestations after cervical anastomotic leakage remain unclear, and were investigated in this study.


METHODS
Consecutive patients undergoing potentially curative transhiatal oesophagectomy (THO) or transthoracic oesophagectomy (TTO) with cervical oesophagogastrostomy between 1993 and 2007 were included. Intrathoracic manifestations after cervical anastomotic leakage were compared following THO and TTO. Multivariable logistic regression analysis was used to identify potential risk factors for intrathoracic manifestations.


RESULTS
Seventy-nine (15.8 per cent) of 501 patients developed anastomotic leakage after THO compared with 50 (15.3 per cent) of 327 after TTO (P = 0.853). Intrathoracic manifestations developed in 21 (27 per cent) and 22 (44 per cent) patients respectively (P = 0.041). A transthoracic approach was the only independent predictor of the development of intrathoracic manifestations in patients with cervical leakage (odds ratio 2.60; P = 0.022). Total hospital stay (P < 0.001), intensive care unit stay (P < 0.001) and in-hospital mortality (P = 0.035) were greater in patients with intrathoracic manifestations than in those without.


CONCLUSIONS
Intrathoracic manifestations of cervical anastomotic leakage are associated with a prolonged hospital stay, carry a higher mortality and occur more frequently after TTO than THO.
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
M
M
van Heijl
A K S
AK
van Wijngaarden
S M
SM
Lagarde
O R C
OR
Busch
J J B
JJ
van Lanschot
M I
MI
van Berge Henegouwen
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002299:Cardia / Q000601:surgery; D003422:Critical Care; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000601:surgery; D004946:Esophagostomy / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012086:Reoperation; D013274:Stomach Neoplasms / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000150:complications*; D013909:Thorax