Treatment of esophagogastric anastomotic leakage after Ivor Lewis esophagectomy
Kondratskyi Y.M.1, Nastashenko I.L.1,2, Svichkar Y.O.1,2, Dobrzhanskyi O.Y.1,2, Ukrainets I.O.1,3, Shudrak Y.A.1,2, Pepenin M.O.1,2, Kolesnyk A.V.1, Turchak V.O.1, Horodetskiy A.V.1,2, Koval N.O.1
- 1Nonprofit Organization National Cancer Institute, Kyiv, Ukraine
- 2Bogomolets National Medical University, Kyiv, Ukraine
- 3Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
Summary. Introduction. Ivor Lewis esophagectomy remains a challenging procedure with a substantial risk of postoperative complications. Esophagogastric anastomotic leakage (EAL) is among the most severe complications, reported in 11.4–21.2% of patients and associated with mortality rates ranging from 7.2 to 35%. To evaluate outcomes of different treatment strategies for EAL after Ivor Lewis esophagectomy in a tertiary cancer center. Materials and methods. A retrospective cohort study included 116 patients who underwent Ivor Lewis esophagectomy with intrathoracic esophagogastric anastomosis at the National Cancer Institute (Kyiv, Ukraine) during 2021–2024. EAL occurred in 21 patients (18.1%). Patients were managed with one of the following approaches: placement of a partially covered self‑expanding metal stent (SEMS) (n=5), endoscopic vacuum therapy (EVT) (n=8), surgical management (Torek procedure) for severe mediastinitis and/or gastric conduit necrosis (n=7), or conservative management (n=1) in a clinically stable patient with a small defect. Endpoints included mortality, length of hospital stay, number of interventions, development of strictures, and need for reoperation; adverse events were also recorded. Results. Overall mortality among patients with EAL was 47.6% (10/21). EVT demonstrated the lowest mortality (12.5%, 1/8). Mortality was 60% (3/5) after SEMS placement and 85.7% (6/7) after the Torek procedure, reflecting the critical baseline condition in this subgroup. The mean length of stay in patients with EAL was 34.8 days. Conclusions. EAL after Ivor Lewis esophagectomy is associated with high mortality and requires prompt diagnosis and individualized treatment. EVT was associated with the most favorable outcomes in our cohort and may be considered the preferred approach when technically feasible; SEMS should be reserved for carefully selected cases, and surgical revision remains a last‑resort option for conduit necrosis or generalized sepsis.
Leave a comment