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Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer

Authors
  • Whooley, Brian P
  • Law, Simon
  • Alexandrou, Andreas
  • Murthy, Sudish C
  • Wong, John
Type
Published Article
Journal
The American Journal of Surgery
Publisher
Elsevier
Publication Date
Jan 01, 2001
Volume
181
Issue
3
Pages
198–203
Identifiers
DOI: 10.1016/S0002-9610(01)00559-1
Source
Elsevier
Keywords
License
Unknown

Abstract

Background: Leakage from esophageal anastomoses is higher than that for other gastrointestinal anastomoses. An intrathoracic anastomotic leak is a potentially catastrophic event. Methods: Patients with and without thoracic anastomotic leakage were compared for predisposing factors. Leak-related mortality was analyzed. Results: Of 475 patients, there were 17 leaks (3.5%). Predisposing technical factors occurred significantly more frequently in patients who leaked. Sixteen such events were identified as contributory in 11 patients. The hospital mortality for patients who leaked was significantly higher (35% versus 9%, P = 0.005). Inadequate drainage and persistent sepsis accounted for 4 of the 6 deaths. The need for inotropic support postoperatively correlated with leak-related mortality (66% versus 0%, P = 0.006), while leak size, time to diagnosis, or method of drainage did not. Conclusions: Thoracic anastomotic leaks are largely preventable. Leak-related mortality for the series was 1% and was most commonly related to inadequate drainage.

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