title: Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy.
abstract: BACKGROUND
  The aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy.
  
  
  METHODS
  Clinical data from 33 patients who developed intrathoracic anastomotic leak were evaluated retrospectively. These patients were selected from 1867 patients undergoing resection carcinoma of the esophagus and reconstruction between January 2003 and December 2012.
  
  
  RESULTS
  Surgical intervention and the reformed "three-tube method" were applied in 13 and 20 patients, respectively. The overall incidence of intrathoracic anastomotic leakage was 1.8%. The median time interval from esophagectomy to diagnosis of leak was 9.7 days. Sixteen patients were confirmed as having leakage by oral contrast computed tomography (CT). Age and interval from surgery to diagnosis of leak were identified as statistically significant parameters between contained and uncontained groups. Moreover, patients with hypoalbuminemia had a longer time to leak closure than patients without hypoalbuminemia. Six patients died from intrathoracic anastomotic leak, with a mortality rate of 18.2%. There was no statistically significant difference in the time to leak closure between patients who underwent surgical exploration and those who received conservative treatment.
  
  
  CONCLUSIONS
  Intrathoracic anastomotic leak after esophagectomy was associated with significant mortality. Once intrathoracic anastomotic leakage following esophagectomy was diagnosed or highly suspected, individualized management strategies should be implemented according to the size of the leak, extent of the abscess, and status of the patient. In the majority of patients with anastomotic leak, we preferred the strategy of conservative treatment.
authors.forename: Juntang
authors.initials: J
authors.lastname: Guo
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Chu
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Naikang
authors.initials: N
authors.lastname: Zhou
authors.forename: Yongfu
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Thoracic Surgery, PLA General Hospital, 28# Fuxing Street, Beijing, China. chaoyangliang301@sina.com.
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Liang
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000175:diagnosis / Q000517:prevention & control*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013909:Thorax / Q000473:pathology*