Treatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions.
Anastomotic Leak
Esophageal Cancer
Esophagectomy
Focus Group
Survey
Journal
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
ISSN: 1442-2050
Titre abrégé: Dis Esophagus
Pays: United States
ID NLM: 8809160
Informations de publication
Date de publication:
14 Dec 2022
14 Dec 2022
Historique:
received:
18
11
2021
revised:
11
03
2022
accepted:
14
02
2022
pubmed:
13
4
2022
medline:
17
12
2022
entrez:
12
4
2022
Statut:
ppublish
Résumé
Anastomotic leak (AL) is a severe complication after esophagectomy. Clinical presentation of AL is diverse and there is large practice variation regarding treatment of AL. This study aimed to explore different AL treatment strategies and their underlying rationale. This mixed-methods study consisted of an international survey among upper gastro-intestinal (GI) surgeons and focus groups with expert upper GI surgeons. The survey included 10 case vignettes and data sources were integrated after separate analysis. The survey was completed by 188 respondents (completion rate 69%) and 6 focus groups were conducted with 20 international experts. Prevention of mortality was the most important goal of primary treatment. Goals of secondary treatment were to promote tissue healing, return to oral feeding and safe hospital discharge. There was substantial variation in the preferred treatment principles (e.g. drainage or defect closure) and modalities (e.g. stent or endoVAC) within different presentations of AL. Patients with local symptoms were treated by supportive means only or by non-surgical drainage and/or defect closure. Drainage was routinely performed in patients with intrathoracic collections and often combined with defect closure. Patients with conduit necrosis were predominantly treated by resection and reconstruction of the anastomosis or by esophageal diversion. This mixed-methods study shows that overall treatment strategies for AL are determined by vitality of the conduit and presence of intrathoracic collections. There is large variation in preferred treatment principles and modalities. Future research may investigate optimal treatment for specific AL presentations and aim to develop consensus-based treatment guidelines for AL after esophagectomy.
Identifiants
pubmed: 35411928
pii: 6566833
doi: 10.1093/dote/doac020
pmc: PMC9753084
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.
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