title: Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study.
abstract: BACKGROUND
  Anastomotic leakage after esophagectomy is a life-threatening complication. No comparative outcome analyses for the different treatment regimens are yet available.
  
  
  METHODS
  In a single-center study, data from all esophagectomy patients from January 1995 to January 2012, including tumor characteristics, surgical procedure, postoperative anastomotic leakage, leakage therapy regimens, APACHE II scores, and mortality, were collected, and predictors of patient survival after anastomotic leakage were analyzed.
  
  
  RESULTS
  Among 366 resected patients, 62 patients (16 %) developed an anastomotic leak, 16 (26 %) of whom died. Therapy regimens included surgical revision (n = 18), endoscopic endoluminal vacuum therapy (n = 17), endoscopic stent application (n = 12), and conservative management (n = 15). APACHE II score at the initiation of treatment for leakage was the strongest predictor of in-hospital mortality (p < 0.0017). Conservatively managed patients showed mild systemic illness (mean APACHE II score 5) and no mortality. In systemically ill patients matched for APACHE II scores (mean, 14.4), endoscopic endoluminal vacuum therapy patients had lower mortality (12 %) compared to surgically treated (50 %, p = 0.01) cases and patients managed by stent placement (83 %, p = 00014, log rank test). No other clinical or laboratory parameters significantly influenced patient survival.
  
  
  CONCLUSIONS
  Endoscopic endoluminal vacuum therapy was the best treatment of anastomotic leakage in systemically ill patients after esophagectomy in this retrospective analysis. It should therefore be considered an important instrument in the management of this disorder.
authors.affiliation: Department of General and Thoracic Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3 (Haus 18), 24105, Kiel, Germany, bodo.schniewind@klinikum-lueneburg.de.
authors.forename: Bodo
authors.initials: B
authors.lastname: Schniewind
authors.forename: Clemens
authors.initials: C
authors.lastname: Schafmayer
authors.forename: Gesa
authors.initials: G
authors.lastname: Voehrs
authors.forename: Jan
authors.initials: J
authors.lastname: Egberts
authors.forename: Witigo
authors.initials: W
authors.lastname: von Schoenfels
authors.forename: Tobias
authors.initials: T
authors.lastname: Rose
authors.forename: Roland
authors.initials: R
authors.lastname: Kurdow
authors.forename: Alexander
authors.initials: A
authors.lastname: Arlt
authors.forename: Mark
authors.initials: M
authors.lastname: Ellrichmann
authors.forename: Christian
authors.initials: C
authors.lastname: Jürgensen
authors.forename: Stefan
authors.initials: S
authors.lastname: Schreiber
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Jochen
authors.initials: J
authors.lastname: Hampe
mesh_terms: D018806:APACHE; D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy; D000368:Aged; D057868:Anastomotic Leak / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000601:surgery / Q000628:therapy; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D003422:Critical Care / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000601:surgery / Q000628:therapy; D016629:Esophagectomy; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D015607:Stents; D015503:Surgical Sponges