Struecker Benjamin, Andreou Andreas, Chopra Sascha, Heilmann Ann-Christin, Spenke Johanna, Denecke Christian, Sauer Igor Maximilian, Bahra Marcus, Pratschke Johann, Biebl Matthias
Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
Dig Surg. 2018;35(5):419-426. doi: 10.1159/000480357. Epub 2017 Nov 7.
Data on the typical time point of occurrence of anastomotic leak (AL) after esophagectomy for esophageal cancer are currently scarce. Therefore, the usefulness of routine radiocontrast agent studies (RRCS) for testing proper healing of the anastomosis after esophagectomy remains unclear. Furthermore, preferred available tools to diagnose postoperative AL and therapeutic options are still under debate.
We present a retrospective analysis of 328 consecutive patients who underwent esophagectomy for esophageal cancer between 2005 and 2015. A RRCS has been performed to date in our center on the fifth postoperative day (POD), before returning to normal oral intake.
In total, 49 of 328 patients developed AL after esophagectomy (15%). A total of 11 patients (23%) developed AL before the RRCS and 34 patients (69%) after an unremarkable RRCS; and 4 patients (8%) with AL were diagnosed by RRCS, resulting in overall sensitivity of 16%. The median time point of occurrence of AL was POD 9, the majority of AL (84%) occurred between POD 1 and 19. Computed tomography led to the diagnosis of AL in 41% of patients. The most frequent therapy of AL was stenting in 47% of patients. Endoscopic vacuum therapy was used in 4 patients.
The majority of AL occurred within the first 3 weeks after esophagectomy without a typical time point. In our series, RRCS on the fifth POD had a low sensitivity of 16%. Therefore, standardized RRCS and fasting till the examination cannot be generally recommended. In case of clinical suspicion of AL, computed tomography of the chest and abdomen with oral contrast agent should be performed, followed by endoscopy. Endoscopic stent placement remains the standard therapy of AL in our center. Endoscopic vacuum therapy evolves as it is an interesting alternative therapeutic option and can be combined with stenting in selected cases.
目前关于食管癌食管切除术后吻合口漏（AL）发生的典型时间点的数据稀缺。因此，常规放射造影剂检查（RRCS）用于检测食管切除术后吻合口愈合情况的实用性仍不明确。此外，诊断术后AL的首选可用工具和治疗选择仍存在争议。
我们对2005年至2015年间连续328例行食管癌食管切除术的患者进行了回顾性分析。迄今为止，我们中心在术后第5天（POD），即恢复正常经口进食前进行了RRCS。
328例患者中共有49例（15%）在食管切除术后发生AL。共有11例患者（23%）在RRCS前发生AL，34例患者（69%）在RRCS无异常后发生AL；4例（8%）发生AL的患者通过RRCS确诊，总体敏感性为16%。AL发生的中位时间点为POD 9，大多数AL（84%）发生在POD 1至19之间。计算机断层扫描在41%的患者中诊断出AL。AL最常见的治疗方法是47%的患者进行支架置入。4例患者使用了内镜下真空治疗。
大多数AL发生在食管切除术后的前三周内，没有典型的时间点。在我们的系列研究中，POD 5的RRCS敏感性较低，为16%。因此，一般不建议进行标准化RRCS以及检查前禁食。如果临床怀疑有AL，应进行口服造影剂的胸部和腹部计算机断层扫描，随后进行内镜检查。内镜支架置入仍然是我们中心AL的标准治疗方法。内镜下真空治疗正在发展，因为它是一种有趣的替代治疗选择，并且在某些情况下可以与支架置入联合使用。
