Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer

Background: Leakage from esophageal anastomoses is higher than that for oth er gastrointestinal anastomoses. An intrathoracic anastomotic leak is a pot entially catastrophic event. Methods: Patients with. and without thoracic anastomotic leakage were compa red for predisposing factors. Leak-related mortality was analyzed. Results: Of 475 patients, there were 17 leaks (3.5%). Predisposing technica l factors occurred significantly more frequently in patients who leaked, Si xteen such events were identified as contributory in 11 patients. The hospi tal mortality for patients who leaked was significantly higher (35% versus 9%, P = 0.005). Inadequate drainage and persistent sepsis accounted for 4 o f the 6 deaths. The need for inotropic support postoperatively correlated w ith leak-related mortality (66% Versus 0%, P = 0.006), while leak size, tim e to diagnosis, or method of drainage did not. Conclusions: Thoracic anastomotic leaks are largely preventable. Leak-relat ed mortality for the series was 1% and was most commonly related to inadequ ate drainage. (C) 2001 Excerpta Medica, Inc. Ah rights reserved.