title: Management and outcomes of anastomotic leaks after oesophagectomy.
abstract: BACKGROUND
  Leaks following oesophagectomy include true anastomotic leaks, leaks from the gastrotomy and gastric conduit necrosis. Historically, these complications were associated with high mortality rates. Recent improvements in outcome have been attributed to the wider use of oesophageal stents in patient management. This study examined outcomes of patients who developed a leak in a single high-volume institution that did not use stenting as a primary treatment modality.
  
  
  METHODS
  All patients undergoing an oesophagectomy between January 2009 and December 2013 were included. Patients were identified from a prospectively maintained database.
  
  
  RESULTS
  A total of 390 oesophagectomies were performed (median age 65 (range 32-81) years). In 96·7 per cent of patients this was a two-stage subtotal oesophagectomy. Overall in-hospital and 90-day mortality rates were both 2·1 per cent (8 patients). Some 31 patients (7·9 per cent) developed a leak (median age 64·5 (range 52-80) years), of whom 27 (87 per cent) were initially managed without surgery, whereas four (13 per cent) required immediate thoracotomy. The median length of stay for patients with a leak was 41·5 (range 15-159) days; none of these patients died.
  
  
  CONCLUSIONS
  Leaks can be managed with excellent outcomes without using oesophageal stents. The results do not support the widespread adoption of endoscopic stenting.
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: B
authors.initials: B
authors.lastname: Dent
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Griffin
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: R
authors.initials: R
authors.lastname: Jones
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: S
authors.initials: S
authors.lastname: Wahed
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: A
authors.initials: A
authors.lastname: Immanuel
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: N
authors.initials: N
authors.lastname: Hayes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D057868:Anastomotic Leak / Q000209:etiology / Q000628:therapy*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D004322:Drainage; D004750:Enteral Nutrition; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007582:Jejunostomy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D013908:Thoracotomy; D006113:United Kingdom
chemical_list: D000890:Anti-Infective Agents