title: Naso-esophageal extraluminal drainage for postoperative anastomotic leak after thoracic esophagectomy for patients with esophageal cancer.
abstract: Postoperative anastomotic leaks and subsequent mediastinal abscess are serious complications. The purpose of this study was to assess the efficacy of naso-esophageal extraluminal drainage after thoracic esophagectomy with gastric conduit reconstruction using a posterior mediastinal route. About 50 of 365 patients (13.7%) with esophageal cancer and postoperative anastomotic leak after curative esophagectomy was investigated. Beginning in June 2009, naso-esophageal extraluminal drainage by inserting a naso-esophageal aspiration tube into the abscess cavity when percutaneous abscess drainage was introduced which was ineffective or technically impossible. Twenty-five patients underwent naso-esophageal extraluminal drainage concomitantly with enteral nutrition. Twenty-one (84%) patients had major leaks, one (4%) minor leak and three (12%) had endoscopically proven conduit necrosis. None of the naso-esophageal extraluminal drainage cases (100%) required reintervention or reoperation and all experienced complete cure (100%) during hospitalization. Endoscopic balloon dilatation was performed for four patients after discharge because of anastomotic stricture. Patients with leaks were divided into two groups: current group (n = 32), treated after June 2009, and preceding group (n = 18), treated prior to the introduction of naso-esophageal extraluminal drainage. Significantly more patients in the preceding group suffered respiratory failure (28% vs. 61%, p = 0.024), and higher reoperation rate (0% vs. 17%, p = 0.042) and hospital mortality (0% vs. 22%, p = 0.013). In the current group, 31 (97%) patients experienced complete cure during hospitalization. Naso-esophageal extraluminal drainage and concomitant enteral nutritional support are less invasive, and effective and powerful methods to treat even major leakage after esophagectomy. These methods may be an alternative management to improve mortality for patients with esophageal cancer.
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.|Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Tsuguaki
authors.initials: T
authors.lastname: Kono
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Akutsu
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Uesato
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Mikito
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kosugi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirano
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan.
authors.forename: Shinich
authors.initials: S
authors.lastname: Okazumi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000379:methods* / Q000401:mortality; D004750:Enteral Nutrition / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D004947:Esophagus / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery; D012086:Reoperation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D035423:Thoracic Cavity / Q000601:surgery; D016896:Treatment Outcome
keywords: anastomotic leak; drainage; esophageal neoplasms