title: Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment.
abstract: BACKGROUND
  Esophagojejunal anastomosis leakage after total gastrectomy (TG) for esophagogastric junction (EGJ) adenocarcinoma (ADC) constitutes one of the most serious and sometimes life-threatening complications. Management remains controversial and still challenging.
  
  
  METHODS
  A total of 198 patients operated for type I and II EGJ ADC were reviewed. Diagnosis of leakage was based on a combination of clinical and radiological findings. It was classified including objective endoscopic and clinical parameters requiring different type of treatment.
  
  
  RESULTS
  Anastomotic leakage was diagnosed in 14 patients (7%). Two cases recovered with conservative therapy. Six cases underwent endoscopy with clips placement in 2 and partially covered self-expandable metal stent placement in 4. Other two cases underwent reoperation with reconstruction of anastomosis and primary repair respectively. In the last four cases emergency surgery with total esophagectomy and diversion was required. Mortality occurred only in 3 of these patients and overall treatment was successful in 11 patients (78.5%).
  
  
  CONCLUSIONS
  No consensus has been reached on the best method of esophagojejunal anastomosis leakage management and the rate of failure remains significant. Different options of treatment are available but early detection and multidisciplinary approaches are the keys to obtain successful results irrespective of the employed strategy.
authors: Department of Digestive Surgery, Regina Elena Cancer Institute, Rome, Italy.
authors: Fabio
authors: F
authors: Carboni
authors: Department of Digestive Surgery, Regina Elena Cancer Institute, Rome, Italy.
authors: Mario
authors: M
authors: Valle
authors: Department of Digestive Surgery, Regina Elena Cancer Institute, Rome, Italy.
authors: Orietta
authors: O
authors: Federici
authors: Department of Digestive Surgery, Regina Elena Cancer Institute, Rome, Italy.
authors: Giovanni Battista
authors: GB
authors: Levi Sandri
authors: Department of Digestive Surgery, Regina Elena Cancer Institute, Rome, Italy.
authors: Ida
authors: I
authors: Camperchioli
authors: Department of Digestive Endoscopy, Regina Elena Cancer Institute, Rome, Italy.
authors: Rocco
authors: R
authors: Lapenta
authors: Department of Digestive Endoscopy, Regina Elena Cancer Institute, Rome, Italy.
authors: Daniela
authors: D
authors: Assisi
authors: Department of Digestive Surgery, Regina Elena Cancer Institute, Rome, Italy.
authors: Alfredo
authors: A
authors: Garofalo
keywords: Esophagogastric junction adenocarcinoma (EGJ ADC); diagnosis; esophagojejunal anastomosis; leakage; treatment