Details

Autor(en) / Beteiligte

• van Heijl, M.
• van Wijngaarden, A. K. S.
• Lagarde, S. M.
• Busch, O. R. C.
• van Lanschot, J. J. B.
• van Berge Henegouwen, M. I.

Titel

Intrathoracic manifestations of cervical anastomotic leaks after transhiatal and transthoracic oesophagectomy

Ist Teil von

• British journal of surgery, 2010-05, Vol.97 (5), p.726-731

Ort / Verlag

Chichester, UK: John Wiley & Sons, Ltd

Erscheinungsjahr

2010

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. They're bad news