Intrathoracic manifestations of cervical anastomotic leaks after transhiatal and transthoracic oesophagectomy

Marilene Heijl, AKS van Wijngaarden, SM Lagarde, ORC Busch, Jan van Lanschot, MIV Henegouwen

Research output: Contribution to journalArticleAcademicpeer-review

34 Citations (Scopus)

Abstract

Background: A possible advantage of cervical oesophagogastrostomy over intrathoracic anastomosis after oesophagectomy is the presumed mild clinical course of cervical anastomotic leakage. The incidence and consequences of intrathoracic manifestations after cervical anastomotic leakage remain unclear, and were investigated in this study. Methods: Consecutive patients undergoing potentially curative transhiatal oesophagectomy (THO) or transthoracic oesophagectomy (TTO) with cervical oesophagogastrostomy between 1993 and 2007 were included. Intrathoracic manifestations after cervical anastomotic leakage were compared following THO and TTO. Multivariable logistic regression analysis was used to identify potential risk factors for intrathoracic manifestations. Results: Seventy-nine (15.8 per cent) of 501 patients developed anastomotic leakage after THO compared with 50 (15.3 per cent) of 327 after TTO (P = 0.853). Intrathoracic manifestations developed in 21 (27 per cent) and 22 (44 per cent) patients respectively (P = 0.041). A transthoracic approach was the only independent predictor of the development of intrathoracic manifestations in patients with cervical leakage (odds ratio 2.60; P = 0.022). Total hospital stay (P < 0.001), intensive care unit stay (P < 0.001) and in-hospital mortality (P = 0.035) were greater in patients with intrathoracic manifestations than in those without. Conclusion: Intrathoracic manifestations of cervical anastomotic leakage are associated with a prolonged hospital stay, carry a higher mortality and occur more frequently after TTO than THO.
Original languageUndefined/Unknown
Pages (from-to)726-731
Number of pages6
JournalBritish Journal of Surgery
Volume97
Issue number5
DOIs
Publication statusPublished - 2010

Cite this