Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
12 06 2023
12 06 2023
Historique:
received:
20
12
2022
revised:
16
03
2023
accepted:
13
04
2023
medline:
3
7
2023
pubmed:
17
5
2023
entrez:
17
5
2023
Statut:
ppublish
Résumé
Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011-2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. -1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. -1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. -21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.
Sections du résumé
BACKGROUND
Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy.
METHODS
A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011-2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders.
RESULTS
Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. -1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. -1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. -21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies.
CONCLUSION
Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.
Identifiants
pubmed: 37196149
pii: 7169396
doi: 10.1093/bjs/znad123
pmc: PMC10364505
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
852-863Subventions
Organisme : Medtronic
Investigateurs
Eric Matthée
(E)
Cettela A M Slootmans
(CAM)
Gijs Ultee
(G)
Suzanne S Gisbertz
(SS)
Wietse J Eshuis
(WJ)
Marianne C Kalff
(MC)
Minke L Feenstra
(ML)
Donald L van der Peet
(DL)
Wessel T Stam
(WT)
Boudewijn Van Etten
(B)
Floris Poelmann
(F)
Nienke Vuurberg
(N)
Jan Willem van den Berg
(JW)
Ingrid S Martijnse
(IS)
Robert M Matthijsen
(RM)
Misha Luyer
(M)
Wout Curvers
(W)
Tom Nieuwenhuijzen
(T)
Annick E Taselaar
(AE)
Ewout A Kouwenhoven
(EA)
Merel Lubbers
(M)
Meindert Sosef
(M)
Frederik Lecot
(F)
Tessa C M Geraedts
(TCM)
Stijn van Esser
(S)
Jan Willem T Dekker
(JWT)
Frits van den Wildenberg
(F)
Wendy Kelder
(W)
Merel Lubbers
(M)
Peter C Baas
(PC)
Job W A de Haas
(JWA)
Henk H Hartgrink
(HH)
Renu R Bahadoer
(RR)
Johanna W van Sandick
(JW)
Koen J Hartemink
(KJ)
Xander Veenhof
(X)
Hein Stockmann
(H)
Burak Gorgec
(B)
Pepijn Weeder
(P)
Marinus J Wiezer
(MJ)
Charlotte M S Genders
(CMS)
Eric Belt
(E)
Bjorn Blomberg
(B)
Peter van Duijvendijk
(P)
Linda Claassen
(L)
David Reetz
(D)
Pascal Steenvoorde
(P)
Walter Mastboom
(W)
Henk Jan Klein Ganseij
(HJ)
Annette D van Dalsen
(AD)
Annalie Joldersma
(A)
Marije Zwakman
(M)
Richard P R Groenendijk
(RPR)
Mahsa Montazeri
(M)
Stuart Mercer
(S)
Benjamin Knight
(B)
Gijs van Boxel
(G)
Richard J McGregor
(RJ)
Richard J E Skipworth
(RJE)
Cristina Frattini
(C)
Alice Bradley
(A)
Magnus Nilsson
(M)
Masaru Hayami
(M)
Biying Huang
(B)
James Bundred
(J)
Richard Evans
(R)
Peter P Grimminger
(PP)
Pieter C van der Sluis
(PC)
Uzun Eren
(U)
John Saunders
(J)
Elena Theophilidou
(E)
Zubair Khanzada
(Z)
Jessie A Elliott
(JA)
Jeroen E H Ponten
(JEH)
Sinead King
(S)
John V Reynolds
(JV)
Bruno Sgromo
(B)
Khalid Akbari
(K)
Samar Shalaby
(S)
Christian A Gutschow
(CA)
Henner Schmidt
(H)
Diana Vetter
(D)
Krishna Moorthy
(K)
Mohamed A H Ibrahim
(MAH)
Grigorious Christodoulidis
(G)
Jari V Räsänen
(JV)
Juha Kauppi
(J)
Henna Söderström
(H)
Renol Koshy
(R)
Dimitrios K Manatakis
(DK)
Dimitrios P Korkolis
(DP)
Dimitrios Balalis
(D)
Aliki Rompu
(A)
Bilal Alkhaffaf
(B)
Mohamed Alasmar
(M)
Moaad Arebi
(M)
Guillaume Piessen
(G)
Frederiek Nuytens
(F)
Sebastien Degisors
(S)
Ahmed Ahmed
(A)
Alex Boddy
(A)
Suraj Gandhi
(S)
Oluwatomini Fashina
(O)
Elke Van Daele
(E)
Piet Pattyn
(P)
William B Robb
(WB)
Mayilone Arumugasamy
(M)
Mohammed Al Azzawi
(M)
Jack Whooley
(J)
Elif Colak
(E)
Engin Aybar
(E)
Ahmet C Sari
(AC)
Mustafa S Uyanik
(MS)
Ahmet B Ciftci
(AB)
Raza Sayyed
(R)
Bushra Ayub
(B)
Ghulam Murtaza
(G)
Aniqa Saeed
(A)
Priyanka Ramesh
(P)
Alexandros Charalabopoulos
(A)
Theodore Liakakos
(T)
Dimitrios Schizas
(D)
Efstratia Baili
(E)
Alkistis Kapelouzou
(A)
Michele Valmasoni
(M)
Elisa Sefora Pierobon
(ES)
Giovanni Capovilla
(G)
Stefano Merigliano
(S)
Silviu Constantinoiu
(S)
Rodica Birla
(R)
Florin Achim
(F)
Cristian Gelu Rosianu
(CG)
Petre Hoara
(P)
Raúl Guevara Castro
(RG)
Andrés Felipe Salcedo
(AF)
Ionut Negoi
(I)
Valentina M Negoita
(VM)
Cezar Ciubotaru
(C)
Bogdan Stoica
(B)
Sorin Hostiuc
(S)
Nicola Colucci
(N)
Stefan P Mönig
(SP)
Charles-Henri Wassmer
(CH)
Jeremy Meyer
(J)
Flavio Roberto Takeda
(FR)
Rubens Antonio Aissar Sallum
(RA)
Ulysses Ribeiro
(U)
Ivan Cecconello
(I)
Enrique Toledo
(E)
Maria Soledad Trugeda
(MS)
María José Fernández
(M)
Carolina Gil
(C)
Sonia Castanedo
(S)
Arda Isik
(A)
Eray Kurnaz
(E)
José Flávio Videira
(JF)
Mariana Peyroteo
(M)
Rita Canotilho
(R)
Jacopo Weindelmayer
(J)
Simone Giacopuzzi
(S)
Carlo Alberto De Pasqual
(CA)
Marcos Bruna
(M)
Fernando Mingol
(F)
Javier Vaque
(J)
Carla Pérez
(C)
Alexander W Phillips
(AW)
Jakub Chmelo
(J)
Joshua Brown
(J)
Renol Koshy
(R)
Laura E Han
(LE)
James A Gossage
(JA)
Andrew R Davies
(AR)
Cara R Baker
(CR)
Mark Kelly
(M)
Mohamed Saad
(M)
Daniele Bernardi
(D)
Luigi Bonavina
(L)
Emanuele Asti
(E)
Carlo Riva
(C)
Rosa Scaramuzzo
(R)
Muhammed Elhadi
(M)
Hazem Abdelkarem Ahmed
(H)
Ahmed Elhadi
(A)
Faruk Ali Elnagar
(F)
Ahmed A A Msherghi
(AAA)
Vanessa Wills
(V)
Cassidy Campbell
(C)
Marisol Perez Cerdeira
(MP)
Scott Whiting
(S)
Neil Merrett
(N)
Amitabha Das
(A)
Christos Apostolou
(C)
Aldenb Lorenzo
(A)
Fabiana Sousa
(F)
José Adelino Barbosa
(JA)
Vítor Devezas
(V)
Elisabete Barbosa
(E)
Cristina Fernandes
(C)
Garett Smith
(G)
Edward Y Li
(EY)
Nazim Bhimani
(N)
Priscilla Chan
(P)
Krishna Kotecha
(K)
Michael W Hii
(MW)
Salena M Ward
(SM)
MaryAnn Johnson
(M)
Matthew Read
(M)
Lynn Chong
(L)
Michael J Hollands
(MJ)
Matthew Allaway
(M)
Arthur Richardson
(A)
Emma Johnston
(E)
Andy Z L Chen
(AZL)
Harsh Kanhere
(H)
Shalvin Prasad
(S)
Patrick McQuillan
(P)
Tim Surman
(T)
Markus I Trochsler
(MI)
W A Schofield
(WA)
Syeda Khadijah Ahmed
(S)
Jessica L Reid
(JL)
Mark C Harris
(MC)
Sivakumar Gananadha
(S)
Jessica Farrant
(J)
Nicole Rodrigues
(N)
James Fergusson
(J)
Andrew Hindmarsh
(A)
Zeeshan Afzal
(Z)
Peter Safranek
(P)
Vijay Sujendran
(V)
Siobhan Rooney
(S)
Carlos Loureiro
(C)
Saioa Leturio Fernández
(SL)
Ismael Díez Del Val
(ID)
Shameen Jaunoo
(S)
Lauren Kennedy
(L)
Ahmed Hussain
(A)
Dimitrios Theodorou
(D)
Tania Triantafyllou
(T)
Charalampos Theodoropoulos
(C)
Theodora Palyvou
(T)
Muhammed Elhadi
(M)
Fatima Abdullah Ben Taher
(FA)
Mustafa Ekheel
(M)
Ahmed A A Msherghi
(AAA)
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
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