Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study.
Author
Ubels, SanderVerstegen, Moniek H P
Klarenbeek, Bastiaan R
Bouwense, Stefan
van Berge Henegouwen, Mark I
Daams, Freek
van Det, Marc J
Griffiths, Ewen A
Haveman, Jan Willem
Heisterkamp, Joos
Nieuwenhuijzen, Grard
Polat, Fatih
Schouten, Jeroen
Siersema, Peter D
Singh, Pritam
Wijnhoven, Bas
Hannink, Gerjon
van Workum, Frans
Rosman, Camiel
Publication date
2023-06-12
Metadata
Show full item recordAbstract
Background: Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. Methods: A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011-2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. Results: Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. -1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. -1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. -21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. Conclusion: Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.Citation
Br J Surg. 2023 Jun 12;110(7):852-863. doi: 10.1093/bjs/znad123.Type
ArticleAdditional Links
http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1365-2168https://academic.oup.com/bjs
PMID
37196149Journal
The British Journal of SurgeryPublisher
Oxford University Pressae974a485f413a2113503eed53cd6c53
10.1093/bjs/znad123