Anastomotic leakage after esophagectomy for esophageal cancer: risk factors and operative treatment
Sander Ubels, Moniek Verstegen, Camiel Rosman, John V. Reynolds
Abstract
Abstract: Esophagectomy with gastric tube reconstruction is the cornerstone of curative treatment for patients with esophageal or gastro-esophageal junction (GEJ) cancer. Anastomotic leakage is a major complication, and may result in major morbidity or mortality. Moreover, anastomotic leakage after esophagectomy may impact on recovery of long-term quality of life and is associated with worse oncologic outcomes. The presentation and consequences of anastomotic leakage represents a spectrum, ranging from a small leak with mild symptoms to a large defect with extensive contamination and fulminant sepsis. Incidence rates and risk factors of anastomotic leakage are well reported, but the literature on factors associated with the outcome of anastomotic leakage and optimum management is scant. Although multiple treatment options for anastomotic leakage, consisting of conservative, radiologic, endoscopic and surgical interventions, are available, there is a large variation in treatment of anastomotic leakage and an evidence-based treatment guideline is currently lacking. The aim of this review is (I) to discuss the literature on factors influencing the occurrence of anastomotic leakage and factors affecting the outcome of patients with anastomotic leakage, and (II) to review the recent literature on the role of surgical management of anastomotic leakage after esophagectomy. New trials and experimental treatments for anastomotic leakage are presented and future directions towards evidence-based treatment of anastomotic leakage are proposed.