[Clinical features and management of pyothorax due to postoperative cervical anastomotic leakage in esophageal cancer surgery].
OBJECTIVE
To investigate the clinical characteristics and managements of pyothorax due to postoperative cervical anastomotic leakage after esophageal cancer surgery.


METHODS
From January 2006 to January 2013, 3342 patients with esophageal carcinoma underwent esophagectomy and cervical esophagogastric anastomosis. Of them, 19 patients developed pyothorax following cervical anastomotic leakage and their clinicopathological data were analyzed retrospectively.


RESULTS
All the patients underwent a cervical anastomosis via a three-incisional approach (right cervicothoracic mid-abdominal incision, RT group, n=1094) or a two-incisional approach (left cervicothoracic incision, LT group, n=2248). The total number of cervical anastomotic leakage cases was 237, of which 152 cases were in LT group (6.8%), and 85 cases in RT group (7.8%), respectively (P=0.287). The incidence of pyothorax was 2.0% (n=3) in LT group, and 18.8% (n=16) in RT group, respectively (P<0.01). Fourteen cases develop pyothorax within 3 days after operation. The main symptoms were high fever, dyspnea and chest pain. All the pyothorax patients received conservative treatments, including thoracic closed drainage, nasogastric tube placement, jejunal stoma, nutritional support, antibiotics and symptomatic treatment. Sixteen cases were cured, while 3 cases were dead.


CONCLUSIONS
The right thoracotomy approach predisposes the cervical anastomotic leakage-associated pyothorax. Sufficient drainage and sufficient nutritional support are critical to the treatment.
Department of Thoracic Surgery, The Fourth Affiliated Hospital, Anyang Tumor Hospital, Henan University of Science and Technology, Henan Anyang 455000, China. shxt53121sh@163.com.
Chong-ming
CM
Hu
Fu-you
FY
Zhou
Ming-fei
MF
Geng
Dong-hong
DH
Fu
Xiao-tian
XT
Shi
D000368:Aged; D057868:Anastomotic Leak; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies