title: Planned delay of oral intake after esophagectomy reduces the cervical anastomotic leak rate and hospital length of stay.
abstract: Cervical anastomotic leak rates are high after esophagectomy. We examined the effect of a purposeful delay in institution of oral diet after esophagectomy on the leak rate and hospital length of stay. A retrospective analysis of 120 patients submitted to esophagectomy with cervical esophagogastric anastomosis was conducted. Eighty-seven resumed diet within 7 days of surgery (early eaters), and 33 had delayed diet until a mean of 12 days after surgery (late eaters). Mean age was 62.3 years; 98 patients were male. One hundred one resections were for cancer, and 49 % of cancer patients received neoadjuvant therapy. The overall leak rate was 17.5 %, and hospital length of stay was 10.9 days. Anastomotic leak rate was 3 % for late eaters versus 23 % for early eaters (OR of 9.57, p = 0.010). Hospital length of stay was 6 days for late eaters versus 11.8 days for early eaters (p < 0.001). Anastomotic leak was significantly associated with increased length of stay (p < 0.001), adding an average of 7.6 days to hospital stay. Respiratory complications (p < 0.001) and delayed gastric emptying (p = 0.014) were also independent predictors of increased length of stay, but early eater status was not. Delayed resumption of oral diet after esophagectomy significantly reduces cervical anastomotic leak rate and avoids the increased length of stay associated with leak.
authors.affiliation: Department of Surgery, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA, jbolton@ochsner.org.
authors.forename: John S
authors.initials: JS
authors.lastname: Bolton
authors.forename: William C
authors.initials: WC
authors.lastname: Conway
authors.forename: Abbas E
authors.initials: AE
authors.lastname: Abbas
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D002277:Carcinoma / Q000601:surgery; D004435:Eating; D004931:Esophageal Achalasia / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011182:Postoperative Care; D011859:Radiography; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013997:Time Factors