Abstract
Background
Anastomotic leak is a major complication after esophagectomy. There is a paucity of
data on long-term oncological outcomes of cervical anastomotic leak after esophagectomy
for cancer. We evaluated the impact of such a leak on postoperative outcomes as well
as on long-term oncological outcomes.
Methods
A retrospective analysis of a prospectively maintained database of patients with esophageal
cancer who underwent esophagectomy with a cervical esophagogastric anastomosis between
2010 and 2017. Patients were divided into 3 groups: patients with no anastomotic leak;
patients with nonsevere (type 1 & 2) leak, and patients with severe (type 3) leak.
A comparison of postoperative and long-term oncological outcomes was made between
the groups.
Results
Two hundred and eight patients were included in this study. Thirty-two (15%) patients
had cervical anastomotic leak, of which 20 (63%) had type 1 and 2 (nonsevere) leak,
and 12 (37%) had type 3 (severe) leak. Overall, 30-day mortality rate was 7%. Mortality
rate was 4% in patients without leak, 15% in patients with nonsevere leak, and 25%
in patients with severe anastomotic leak (P = .007). Overall median survival was 42 months. Patients with severe leak had poorer
overall survival compared to patients with nonsevere and no anastomotic leak (6, 38,
and 39 months, respectively, P = .011). There was no difference in disease-free survival of patients with or without
anastomotic leak.
Conclusion
Leakage from cervical anastomosis after esophagectomy had no impact on disease-free
survival of patients with esophageal cancer. Severe anastomotic leak was associated
with lower overall survival, probably due to a high rate of postoperative mortality.
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Article info
Publication history
Published online: November 06, 2021
Accepted:
October 1,
2021
Footnotes
Vladimir Tverskov and Ory Wiesel are co-first authors.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
