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Treatment for anastomotic leakage after minimally invasive Ivor Lewis esophagectomy

Merel Lubbers, MD1, Frans van Workum, MD2, Gijs Berkelmans, MD3, Camiel Rosman, MD, PhD4, Misha Luyer, MD, PhD3, Grard Nieuwenhuijzen, MD, PhD3, Marc van Det, MD, PhD1, Ewout Kouwenhoven, MD, PhD1. 1Ziekenhuis Groep Twente, 2Canisius-Wilhelmina Ziekenhuis, 3Catharina Ziekenhuis, 4Radboud Universitair Medisch Centrum

Introduction: Anastomotic leakage (AL) is a life threatening complication after minimally invasive Ivor Lewis esophagectomy (tMIE ILE) and has diverse treatment strategies such as conservative treatment, endoscopic treatment and surgery. However, there is no consensus on which treatment strategy is best. The aim of this study was to analyse various therapeutic strategies for AL and their outcomes.

Methods and procedures: This retrospective multicentre study was performed in three high-volume hospitals. All patients that developed AL after tMIE ILE in the period of January 2011- July 2016 were included. The different endoscopic (stenting, clipping and suction-drainage) and surgical treatments and their success-rate were described; success was defined as clinical improvement after primary treatment. Primary endpoint was the time until oral feeding was resumed. Secondary endpoints were hospital stay and the total amount of surgical, endoscopic and radiologic interventions.

Results: In total 83 patients that developed AL were identified; four patients received antibiotics only. In the remaining 79 patient, endoscopic treatment was performed as primary treatment in 53%; 47% received primary surgical treatment. Basic variables were similar in these groups.

Median postoperative day of diagnosis of AL was day 7 in the endoscopic-group and day 5 in the surgical-group (p=0.038). Admission to the ICU as a result of the leakage was necessary in 52% in the endoscopic-group versus 95% in the surgical-group (p<0.001). However, median ICU-stay was significantly shorter in the endoscopic-group (7 days versus 12 days, p=0.020). Success-rate of the primary treatment was similar; 76% and 73% respectively (p=0.743). Primary and secondary endpoints were comparable for both the endoscopic- and surgical-group; median time until oral feeding was resumed was 36 days and 31 days respectively (p=0.232), median total hospital stay 36 days and 40 days respectively (p=0.378) and the median number of interventions was 5 in both groups (p=0.378).

Conclusion: Endoscopic treatment appears to be a safe and efficient therapy for AL after tMIE ILE. A patient-tailored approach based on the condition of the patient and the morphology of the leak can be adapted to avoid surgery in a selection of patients. This may prevent surgical re-operations and reduce ICU admissions.  


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88000

Program Number: P724

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

56

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