title: Impact of anastomotic leak on outcomes after transhiatal esophagectomy.
abstract: BACKGROUND
  The development of anastomotic leaks and/or strictures can be associated with considerable morbidity and impairment of quality of life. In the current study, we evaluated the outcomes of patients who developed anastomotic complications after esophagectomy to elucidate the impact of these events on morbidity, mortality, and subsequent need for dilation.
  
  
  METHODS
  We analyzed retrospectively the clinical course of 235 patients who underwent transhiatal esophagectomy for cancer from 2001 to 2009. Patients with confirmed anastomotic leaks were identified and classified with the following scale: class 1: Radiographic leak only, no intervention; class 2: leak requiring opening of the wound, cervical and/or percutaneous drainage; class 3: disruption of anastomosis (10-50% circumference) with perianastomotic abscess requiring video-assisted thoracoscopic surgery or thoracotomy; and class 4: gastric tip necrosis with anastomotic separation (>50% circumference).
  
  
  RESULTS
  Anastomotic leaks were encountered in 30 patients (13%). Anastomotic leaks were associated with greater morbidity (70% vs 47%; P = .02) and stricture formation (57% vs 19%; P = .0001). Mortality was not different. Increasing leak class was associated with an increased need for postoperative anastomotic dilations (P = .016).
  
  
  CONCLUSIONS
  Anastomotic integrity after esophagectomy has a substantial impact on perioperative course and long-term swallowing. A more formal radiographic and endoscopic leak classification system seems justified.
authors.affiliation: Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Pittsburgh, PA 15232, USA. schuchertmj@upmc.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: Ghulam
authors.initials: G
authors.lastname: Abbas
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: Omar
authors.initials: O
authors.lastname: Awais
authors.forename: Marco
authors.initials: M
authors.lastname: Santana
authors.forename: Raphael
authors.initials: R
authors.lastname: Pereira
authors.forename: Alicia
authors.initials: A
authors.lastname: Oostdyk
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
mesh_terms: D000230:Adenocarcinoma; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000145:classification* / Q000175:diagnosis / Q000209:etiology