Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study
Sander Ubels, Moniek Verstegen, Bastiaan Klarenbeek, Stefan A.W. Bouwense, Mark I. van Berge Henegouwen, Freek Daams, Marc J. van Det, Ewen A. Griffiths, Jan Willem Haveman, Joos Heisterkamp, Grard A. P. Nieuwenhuijzen, Fatih Polat, Jeroen Schouten, Peter D. Siersema, Pritam Singh, Bas P. L. Wijnhoven, Gerjon Hannink, Frans van Workum, Camiel Rosman, the TENTACLE—Esophagus Collaborative Group, Eric Matthée, Cettela A.M. Slootmans, Gijs Ultee, Suzanne S. Gisbertz, Wietse J. Eshuis, Marianne C. Kalff, Minke L. Feenstra, Donald L. van der Peet, Wessel T. Stam, Boudewijn van Etten, Floris B. Poelmann, Nienke Vuurberg, Jan Willem van den Berg, Ingrid S. Martijnse, R M Matthijsen, Misha Luyer, Wout Curvers, Tom Nieuwenhuijzen, Annick E Taselaar, Ewout A. Kouwenhoven, Merel Lubbers, Meindert N. Sosef, Frederik Lecot, Tessa C. M. Geraedts, Stijn van Esser, Jan Willem T. Dekker, F. van den Wildenberg, Wendy Kelder, Merel Lubbers, Peter C. Baas, Job W A de Haas, Henk H. Hartgrink, Renu R. Bahadoer, Johanna W. van Sandick, Koen J. Hartemink, Xander Veenhof, Hein B.A.C. Stockmann, Burak Görgeç, Pepijn D. Weeder, Marinus J. Wiezer, Charlotte M. S. Genders, Eric J.T. Belt, Bjørn Blomberg, Peter van Duijvendijk, Linda Claassen, David Reetz, Pascal Steenvoorde, W. J. B. Mastboom, Henk Jan Klein Ganseij, Annette D van Dalsen, Annalie Joldersma, Marije Zwakman, R.P. Groenendijk, Mahsa Montazeri, Stuart Mercer, Benjamin Knight, Gijs van Boxel, Richard McGregor, Richard J. E. Skipworth, Cristina Frattini, Alice Bradley, Magnus Nilsson, Masaru Hayami, Biying Huang, James Bundred, Richard Evans, Peter Grimminger, Pieter C. van der Sluis, Eren Uzun, J. Saunders, Elena Theophilidou, Zubair Khanzada, Jessie A. Elliott, Jeroen E. H. Ponten, Sinéad King, John V. Reynolds, Bruno Sgromo, Khalid Akbari, Samar Shalaby, Christian A. Gutschow
Abstract
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.