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Erschienen in: European Surgery 6/2018

18.09.2018 | original article

Management of esophagojejunal anastomosis leakage after total gastrectomy

verfasst von: MD, PhD Drs. Pablo Priego, MD Pietro Giordano, MD Marta Cuadrado, MD Araceli Ballestero, MD, PhD Julio Galindo, MD, PhD Eduardo Lobo

Erschienen in: European Surgery | Ausgabe 6/2018

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Summary

Background

Esophagojejunal anastomosis leakage (EAL) after total gastrectomy for gastric adenocarcinoma represents one of the most serious complications, with increased mortality rates and prolonged hospital stay after surgery. Treatment options include conservative management, endoscopic therapy, and surgery. The aim of the study was to present our experience in the management of this fatal complication.

Patients and methods

From 2000 to 2016, we retrospectively reviewed all cases of EAL after total gastrectomy treated in our institution. The diagnosis of leakage was based on a combination of clinical and radiological findings. The type of treatment, postoperative stay, complications, cure, and mortality rates were analyzed.

Results

EAL was diagnosed in 32 patients (9.5%), of whom 24 (75%) recovered with conservative therapy and two (6.2%) with OVESCO OTSC placement. The other six patients (18.8%) underwent surgery: two cases of abdominal drainage, two cases of primary repair, and two cases of reconstruction of anastomosis. Overall treatment was successful in 26 patients (81.2%) while mortality occurred in six cases (18.8%).

Conclusion

Conservative management of EAL is an option for clinically stable patients with small leakages with a high rate of cure. Re-operation results in a high mortality rate and should only be considered when conservative management is not successful or in very unstable patients.
Literatur
1.
Zurück zum Zitat Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23. CrossRef Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23. CrossRef
2.
Zurück zum Zitat Roder JD, Böttcher K, Siewert JR, et al. Prognostic factors in gastric carcinoma. Results of the German Gastric Carcinoma Study 1992. Cancer. 1993;72(7):2089–97. CrossRef Roder JD, Böttcher K, Siewert JR, et al. Prognostic factors in gastric carcinoma. Results of the German Gastric Carcinoma Study 1992. Cancer. 1993;72(7):2089–97. CrossRef
3.
Zurück zum Zitat An JY, Kim KM, Kim YM, et al. Surgical complications in gastric cancer patients preoperatively treated with chemotherapy: their risk factors and clinical relevance. Ann Surg Oncol. 2012;19(8):2452–8. CrossRef An JY, Kim KM, Kim YM, et al. Surgical complications in gastric cancer patients preoperatively treated with chemotherapy: their risk factors and clinical relevance. Ann Surg Oncol. 2012;19(8):2452–8. CrossRef
4.
Zurück zum Zitat Planells Roig MV, López Martínez C, Ballester C, et al. Factores predictivos de mortalidad en pacientes sometidos a gastrectomía total por adenocarcinoma gástrico. Cir Esp. 1998;64:129–35. Planells Roig MV, López Martínez C, Ballester C, et al. Factores predictivos de mortalidad en pacientes sometidos a gastrectomía total por adenocarcinoma gástrico. Cir Esp. 1998;64:129–35.
5.
Zurück zum Zitat East German Study Group for Quality Control in Operative Medicine and Regional Development in Surgery, Meyer L, Meyer F, Dralle H, et al. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric adenocarcinoma. Langenbecks Arch Surg. 2005;390:510–6. CrossRef East German Study Group for Quality Control in Operative Medicine and Regional Development in Surgery, Meyer L, Meyer F, Dralle H, et al. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric adenocarcinoma. Langenbecks Arch Surg. 2005;390:510–6. CrossRef
6.
Zurück zum Zitat Sauvanet A, Mariette C, Thomas P, et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg. 2005;201:253–62. CrossRef Sauvanet A, Mariette C, Thomas P, et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg. 2005;201:253–62. CrossRef
7.
Zurück zum Zitat Lang H, Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000;26(2):168–71. CrossRef Lang H, Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000;26(2):168–71. CrossRef
8.
Zurück zum Zitat Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade. Hepatogastroenterology. 2004;51:613–7. PubMed Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade. Hepatogastroenterology. 2004;51:613–7. PubMed
9.
Zurück zum Zitat Deguchi Y, Fukagawa T, Morita S, et al. Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg. 2012;36(7):1617–22. CrossRef Deguchi Y, Fukagawa T, Morita S, et al. Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg. 2012;36(7):1617–22. CrossRef
10.
Zurück zum Zitat Sierzega M, Kolodziejczyk P, Kulig J, and the Polish Gastric Cancer Study Group. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97(7):1035–42. CrossRef Sierzega M, Kolodziejczyk P, Kulig J, and the Polish Gastric Cancer Study Group. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97(7):1035–42. CrossRef
11.
Zurück zum Zitat Robb WB, Messager M, Goere D, et al. Predictive factors of postoperative mortality gastric adenocarcinoma. JAMA Surg. 2013;148(7):624–31. CrossRef Robb WB, Messager M, Goere D, et al. Predictive factors of postoperative mortality gastric adenocarcinoma. JAMA Surg. 2013;148(7):624–31. CrossRef
12.
Zurück zum Zitat Yoo HM, Lee HH, Shim JH, et al. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol. 2011;104:734–40. CrossRef Yoo HM, Lee HH, Shim JH, et al. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol. 2011;104:734–40. CrossRef
13.
Zurück zum Zitat Ruiz de Adana JC, Ortega Deballon P, Alonso Garcia MT, et al. Morbimortalidad atribuible a la fístula esofagoyeyunal tras gastrectomía total por cáncer gástrico. Cir Esp. 2001;70:3–5. CrossRef Ruiz de Adana JC, Ortega Deballon P, Alonso Garcia MT, et al. Morbimortalidad atribuible a la fístula esofagoyeyunal tras gastrectomía total por cáncer gástrico. Cir Esp. 2001;70:3–5. CrossRef
14.
Zurück zum Zitat Persson S, Rouvelas I, Kumagai K, et al. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure. Endosc Int Open. 2016;4(4):E420–E6. CrossRef Persson S, Rouvelas I, Kumagai K, et al. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure. Endosc Int Open. 2016;4(4):E420–E6. CrossRef
15.
Zurück zum Zitat Bruce J, Krukowski ZH, Al-Khairy G, et al. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88:1157–68. CrossRef Bruce J, Krukowski ZH, Al-Khairy G, et al. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88:1157–68. CrossRef
16.
Zurück zum Zitat Carboni F, Valle M, Federici O, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol. 2016;7(4):515–22. CrossRef Carboni F, Valle M, Federici O, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol. 2016;7(4):515–22. CrossRef
17.
Zurück zum Zitat Schuchert MJ, Abbas G, Nason KS, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery. 2010;148:831–8. discussion 838–40. CrossRef Schuchert MJ, Abbas G, Nason KS, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery. 2010;148:831–8. discussion 838–40. CrossRef
18.
Zurück zum Zitat Lee S, Ahn JY, Jung HY, et al. Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage. Surg Endosc. 2013;27(11):4232–40. CrossRef Lee S, Ahn JY, Jung HY, et al. Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage. Surg Endosc. 2013;27(11):4232–40. CrossRef
19.
Zurück zum Zitat Aurello P, Magistri P, D’Angelo F, et al. Treatment of esophagojejunal anastomosis leakage: a systematic review from the last twodecades. Am Surg. 2015;81(5):450–3. PubMed Aurello P, Magistri P, D’Angelo F, et al. Treatment of esophagojejunal anastomosis leakage: a systematic review from the last twodecades. Am Surg. 2015;81(5):450–3. PubMed
20.
Zurück zum Zitat Tonouchi H, Mohri Y, Tanaka K, et al. Diagnostic sensitivity of contrast swallow for leakage after gastric resection. World J Surg. 2007;31(1):128–31. CrossRef Tonouchi H, Mohri Y, Tanaka K, et al. Diagnostic sensitivity of contrast swallow for leakage after gastric resection. World J Surg. 2007;31(1):128–31. CrossRef
21.
Zurück zum Zitat Lamb PJ, Griffin SM, Chandrashekar MV, et al. Prospective study of routine contrast radiology after total gastrectomy. Br J Surg. 2004;91(8):1015–9. CrossRef Lamb PJ, Griffin SM, Chandrashekar MV, et al. Prospective study of routine contrast radiology after total gastrectomy. Br J Surg. 2004;91(8):1015–9. CrossRef
22.
Zurück zum Zitat Migita K, Takayama T, Matsumoto S, et al. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16(9):1659–65. CrossRef Migita K, Takayama T, Matsumoto S, et al. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16(9):1659–65. CrossRef
23.
Zurück zum Zitat Upponi S, Ganeshan A, D’Costa H, et al. Radiological detection of post-oesophaguectomy anastomotic leak—a comparison between multidetector CT and fluoroscopy. Br J Radiol. 2008;81:545–8. CrossRef Upponi S, Ganeshan A, D’Costa H, et al. Radiological detection of post-oesophaguectomy anastomotic leak—a comparison between multidetector CT and fluoroscopy. Br J Radiol. 2008;81:545–8. CrossRef
24.
Zurück zum Zitat Wang Q, Liu ZS, Qian Q, et al. Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support. World J Gastroenterol. 2008;14(32):5073–7. CrossRef Wang Q, Liu ZS, Qian Q, et al. Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support. World J Gastroenterol. 2008;14(32):5073–7. CrossRef
25.
Zurück zum Zitat Kim YJ, Shin SK, Lee HJ, et al. Endoscopic management of anastomotic leakage after gastrectomy for gastric cancer: how efficacious is it? Scand J Gastroenterol. 2013;48:111–8. CrossRef Kim YJ, Shin SK, Lee HJ, et al. Endoscopic management of anastomotic leakage after gastrectomy for gastric cancer: how efficacious is it? Scand J Gastroenterol. 2013;48:111–8. CrossRef
26.
Zurück zum Zitat Kumar N, Thompson CC. Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am. 2013;23:123–36. CrossRef Kumar N, Thompson CC. Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am. 2013;23:123–36. CrossRef
27.
Zurück zum Zitat Dişibeyaz S, Köksal AŞ, Parlak E, et al. Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature. Clin Res Hepatol Gastroenterol. 2012;36:614–21. CrossRef Dişibeyaz S, Köksal AŞ, Parlak E, et al. Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature. Clin Res Hepatol Gastroenterol. 2012;36:614–21. CrossRef
29.
Zurück zum Zitat Kobara H, Mori H, Fujihara S, et al. Outcomes of gastrointestinal defect closure with an over-the-scope clip system in a multicenter experience: an analysis of a successful suction method. World J Gastroenterol. 2017;23(9):1645–56. CrossRef Kobara H, Mori H, Fujihara S, et al. Outcomes of gastrointestinal defect closure with an over-the-scope clip system in a multicenter experience: an analysis of a successful suction method. World J Gastroenterol. 2017;23(9):1645–56. CrossRef
30.
Zurück zum Zitat Mizrahi I, Eltawil R, Haim N, et al. The clinical utility of over-the-scope clip for the treatment of gastrointestinal defects. J Gastrointest Surg. 2016;20(12):1942–9. CrossRef Mizrahi I, Eltawil R, Haim N, et al. The clinical utility of over-the-scope clip for the treatment of gastrointestinal defects. J Gastrointest Surg. 2016;20(12):1942–9. CrossRef
31.
Zurück zum Zitat Raimondo D, Sinagra E, Facella T, et al. Self-expandable metal stent placement for closure of a leak after total gastrectomy for gastric cancer: report on three cases and review of the literature. Case Rep Gastrointest Med. 2014;2014:409283. PubMedPubMedCentral Raimondo D, Sinagra E, Facella T, et al. Self-expandable metal stent placement for closure of a leak after total gastrectomy for gastric cancer: report on three cases and review of the literature. Case Rep Gastrointest Med. 2014;2014:409283. PubMedPubMedCentral
32.
Zurück zum Zitat Shim CN, Kim HI, Hyung WJ, et al. Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy? Surg Endosc. 2014;28:833–40. CrossRef Shim CN, Kim HI, Hyung WJ, et al. Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy? Surg Endosc. 2014;28:833–40. CrossRef
33.
Zurück zum Zitat Kumar N, Thompson CC. Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am. 2013;23:123–36. CrossRef Kumar N, Thompson CC. Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am. 2013;23:123–36. CrossRef
34.
Zurück zum Zitat Van Boeckel PG, Dua KS, Weusten BL, et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol. 2012;12:19. CrossRef Van Boeckel PG, Dua KS, Weusten BL, et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol. 2012;12:19. CrossRef
35.
Zurück zum Zitat Hoeppner J, Kulemann B, Seifert G, et al. Covered selfexpanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses. Surg Endosc. 2014;28:1703–11. CrossRef Hoeppner J, Kulemann B, Seifert G, et al. Covered selfexpanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses. Surg Endosc. 2014;28:1703–11. CrossRef
36.
Zurück zum Zitat Feith M, Gillen S, Schuster T, et al. Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clin Gastroenterol Hepatol. 2011;9:202–10. CrossRef Feith M, Gillen S, Schuster T, et al. Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clin Gastroenterol Hepatol. 2011;9:202–10. CrossRef
37.
Zurück zum Zitat Fischer A, Bausch D, Richter-Schrag HJ. Use of a specially designed partially covered self-expandable metal stent (PSEMS) with a 40-mm diameter for the treatment of upper gastrointestinal suture or staple line leaks in 11 cases. Surg Endosc. 2013;27:642–7. CrossRef Fischer A, Bausch D, Richter-Schrag HJ. Use of a specially designed partially covered self-expandable metal stent (PSEMS) with a 40-mm diameter for the treatment of upper gastrointestinal suture or staple line leaks in 11 cases. Surg Endosc. 2013;27:642–7. CrossRef
38.
Zurück zum Zitat Kucukay F, Okten RS, Parlak E, et al. Self-expanding covered metallic stent treatment of esophagojejunostomy fistulas. Abdom Imaging. 2013;38:244–8. CrossRef Kucukay F, Okten RS, Parlak E, et al. Self-expanding covered metallic stent treatment of esophagojejunostomy fistulas. Abdom Imaging. 2013;38:244–8. CrossRef
Metadaten
Titel
Management of esophagojejunal anastomosis leakage after total gastrectomy
verfasst von
MD, PhD Drs. Pablo Priego
MD Pietro Giordano
MD Marta Cuadrado
MD Araceli Ballestero
MD, PhD Julio Galindo
MD, PhD Eduardo Lobo
Publikationsdatum
18.09.2018
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 6/2018
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-018-0556-7