gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

Therapeutic management of esophageal anastomotic leakage after subtotal esophagectomy for esophageal carcinoma – institutional experience of a high volume centre

Meeting Abstract

  • Michael Tachezy - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Lena Tomkötter - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Florian Gebauer - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Yogesh Vashist - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Maximilian Bockhorn - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Jakob Izbicki - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
  • Emre Yekebas - Universitätsklinikum Hemburg-Eppendorf, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch078

DOI: 10.3205/11dgch078, URN: urn:nbn:de:0183-11dgch0781

Veröffentlicht: 20. Mai 2011

© 2011 Tachezy et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Esophagectomy is presently the gold standard in the treatment of localized esophageal cancer. The surgical treatment is associated with a high rate of morbidity and mortality, caused, amongst others, by anastomotic leaks. We evaluate our management strategies and outcome of anastomotic leakages after transhiatal and transthoracic esophagectomy of the last 20 years. Furthermore, we search for possible predicting factors of anastomotic leak associated morbidity and mortality, to improve the treatment strategies of this severe surgical complication.

Materials and methods: Clinical data from 554 patients with resectable carcinoma of the esophagus, who underwent subtotal esophagectomy at University Medical Center Hamburg-Eppendorf between May 1992 and July 2009, were collected. Leakages after subtotal esophagectomy are defined as a clinical, endoscopic or radiological diagnosed dehiscence of the esophago-enteric anastomosis and were grouped in four grades.

Results: One hundred-one patients with an anastomotic leak were identified (101 cervical, incidence 32% and 31 intrathoracic anastomosis, incidence 22%, p=0.026). There were no significant differences in leakage associated symptoms and co-morbidities in cervical and intrathoracic anastomotic site. Treatments were surgical (31%), endoscopic (28%) or conservative (41%). Twenty three (18%) patients died during hospitalisation as a consequence of anastomic leakage. Although cervical anastomoses more often develop leakage, they can usually be treated sufficiently by simple conservative strategies like wound revision. In contrast, intrathoracic leakages are less frequent, but have a significant higher rate of major complications such as sepsis or mediastinitis. Nevertheless, in-hospital mortality shows no significant difference regarding location of anastomosis. Grade of leakage (p=0.020, OR 2.217, 95%CI 1.134/4.335) is an independent predictive parameter for in hospital mortality.

Conclusion: Irrespective of surgical improvements, the incidence of anastomotic leakages after esophagectomy is still high, even in a high volume center. But this feared surgical complication can be treated sufficiently in an interdisciplinary setting.