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Article: Treatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions

TitleTreatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions
Authors
KeywordsAnastomotic Leak
Esophageal Cancer
Esophagectomy
Focus Group
Survey
Issue Date12-Apr-2022
PublisherOxford University Press
Citation
Diseases of the Esophagus, 2022, v. 35, n. 12, p. 1-9 How to Cite?
Abstract

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.


Persistent Identifierhttp://hdl.handle.net/10722/331650
ISSN
2023 Impact Factor: 2.3
2023 SCImago Journal Rankings: 1.038
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorUbels, Sander-
dc.contributor.authorLubbers, Merel-
dc.contributor.authorVerstegen, Moniek H P-
dc.contributor.authorBouwense, Stefan A W-
dc.contributor.authorVan Daele, Elke-
dc.contributor.authorFerri, Lorenzo-
dc.contributor.authorGisbertz, Suzanne S-
dc.contributor.authorGriffiths, Ewen A-
dc.contributor.authorGrimminger, Peter-
dc.contributor.authorHanna, George-
dc.contributor.authorHubka, Michal-
dc.contributor.authorLaw, Simon-
dc.contributor.authorLow, Donald-
dc.contributor.authorLuyer, Misha-
dc.contributor.authorMerritt, Robert E-
dc.contributor.authorMorse, Christopher-
dc.contributor.authorMueller, Carmen L-
dc.contributor.authorNieuwenhuijzen, Grard A P-
dc.contributor.authorNilsson, Magnus-
dc.contributor.authorReynolds, John V-
dc.contributor.authorRibeiro, Ulysses-
dc.contributor.authorRosati, Riccardo-
dc.contributor.authorShen, Yaxing-
dc.contributor.authorWijnhoven, Bas P L-
dc.contributor.authorKlarenbeek, Bastiaan R-
dc.contributor.authorVan Workum, Frans-
dc.contributor.authorRosman, Camiel-
dc.date.accessioned2023-09-21T06:57:41Z-
dc.date.available2023-09-21T06:57:41Z-
dc.date.issued2022-04-12-
dc.identifier.citationDiseases of the Esophagus, 2022, v. 35, n. 12, p. 1-9-
dc.identifier.issn1120-8694-
dc.identifier.urihttp://hdl.handle.net/10722/331650-
dc.description.abstract<p></p><p>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.<br></p>-
dc.languageeng-
dc.languageeng-
dc.publisherOxford University Press-
dc.relation.ispartofDiseases of the Esophagus-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectAnastomotic Leak-
dc.subjectEsophageal Cancer-
dc.subjectEsophagectomy-
dc.subjectFocus Group-
dc.subjectSurvey-
dc.titleTreatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions-
dc.typeArticle-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1093/dote/doac020-
dc.identifier.scopuseid_2-s2.0-85144585760-
dc.identifier.volume35-
dc.identifier.issue12-
dc.identifier.spage1-
dc.identifier.epage9-
dc.identifier.eissn1442-2050-
dc.identifier.isiWOS:000784750300001-
dc.identifier.issnl1120-8694-

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