title: Modified pleural tenting for prevention of anastomotic leak after Ivor Lewis esophagogastrectomy.
abstract: BACKGROUND
  The most dangerous complication following esophagogastrectomy for esophageal cancer is anastomotic leakage. Surgical interventions described did not have a major impact in reducing the risk of occurrence. On the other hand, pleural tenting has been used for more than a decade by thoracic surgeons to prevent prolonged air leak after formal upper lobectomy with excellent results.
  
  
  METHODS
  A retrospective analysis of 114 cases of esophagogastrectomy for cancer of esophagus or cardioesophageal junction is presented. Patients have been divided in 2 groups. In group B modified pleural tenting was used to prevent a potential anastomotic leak, while in group A, the control group, pleural tenting was not used. Evaluation of modified pleural tenting in preventing anastomotic leakage was the aim of the study.
  
  
  RESULTS
  The pleural tenting group showed a significant decrease in anastomotic leak. In 1 patient versus 8 in group without pleural tenting the complication appeared (P = .032). The risk for an anastomotic leakage in group without pleural tenting was almost 9 times greater (odds ratio: 9.143, 95% confidence interval: lower bound 1.104, upper bound 75.708). The 30-day mortality, although lower in pleural tenting group, was not statistically significant.
  
  
  CONCLUSIONS
  Pleural tenting is a safe, fast, and effective technique for prevention of anastomotic leakage after Ivor Lewis esophagogastrectomy. Subpleural blanketing of intrathoracic anastomosis could diminish the consequences of a possible anastomotic leak.
authors.affiliation: Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece. asteriouchris@yahoo.gr
authors.forename: Christos
authors.initials: C
authors.lastname: Asteriou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Barbetakis
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Lalountas
authors.forename: Athanassios
authors.initials: A
authors.lastname: Kleontas
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Tsilikas
mesh_terms: D000230:Adenocarcinoma / Q000517:prevention & control / Q000601:surgery; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000517:prevention & control* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000517:prevention & control / Q000601:surgery; D004938:Esophageal Neoplasms / Q000517:prevention & control* / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000601:surgery*; D010995:Pleural Diseases / Q000517:prevention & control / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013524:Surgical Flaps