Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
Langenbecks Arch Surg. 2023 Feb 15;408(1):90. doi: 10.1007/s00423-023-02826-3.
Anastomotic leakages after esophagectomies continue to constitute significant morbidity and mortality. Intrathoracic anastomoses pose a high risk for mediastinitis, sepsis, and death, if a leak is not addressed timely and appropriately. However, there are no standardized treatment recommendations or algorithms as for how to treat these leakages.
The study included all patients at the University Hospital Regensburg, who developed an anastomotic leakage after esophagectomy with gastric pull-up reconstruction from 2007 to 2022. Patients receiving conventional treatment options for an anastomotic leakage (stents, drainage tubes, clips, etc.) were compared to patients receiving endoscopic vacuum-assisted closure (eVAC) therapy as their mainstay of treatment. Treatment failure was defined as cervical esophagostomy formation or death.
In total, 37 patients developed an anastomotic leakage after esophagectomy with a gastric pull-up reconstruction. Twenty patients were included into the non-eVAC cohort, whereas 17 patients were treated with eVAC. Treatment failure was observed in 50% of patients (n = 10) in the non-eVAC cohort and in 6% of patients (n = 1) in the eVAC cohort (p < 0.05). The 90-day mortality in the non-eVAC cohort was 15% (n = 3) compared to 6% (n = 1) in the eVAC cohort. Cervical esophagostomy formation was required in 40% of cases (n = 8) in the non-eVAC cohort, whereas no patient in the eVAC cohort underwent cervical esophagostomy formation.
eVAC therapy for leaking esophagogastric anastomoses appears to be superior to other treatment strategies as it significantly reduces morbidity and mortality. Therefore, we suggest eVAC as an essential component in the treatment algorithm for anastomotic leakages following esophagectomies, especially in patients with intrathoracic anastomoses.
食管切除术后吻合口漏仍然是导致较高发病率和死亡率的主要原因。如果不及时、适当地处理,发生吻合口漏的胸内吻合口会导致纵隔炎、脓毒症和死亡的风险很高。然而,对于如何治疗这些吻合口漏,目前还没有标准化的治疗建议或算法。
该研究纳入了 2007 年至 2022 年期间在雷根斯堡大学医院接受胃食管拉牵引重建的食管切除术后发生吻合口漏的所有患者。将接受传统吻合口漏治疗方案(支架、引流管、夹等)的患者与接受内镜真空辅助闭合(eVAC)治疗的患者进行比较,后者是其主要治疗方法。治疗失败定义为颈段食管造口术形成或死亡。
共有 37 例患者在接受胃食管拉牵引重建的食管切除术后发生吻合口漏。20 例患者被纳入非-eVAC 组,17 例患者接受 eVAC 治疗。非-eVAC 组中有 50%(n=10)的患者治疗失败,而 eVAC 组中只有 6%(n=1)的患者治疗失败(p<0.05)。非-eVAC 组的 90 天死亡率为 15%(n=3),而 eVAC 组为 6%(n=1)。非-eVAC 组中有 40%(n=8)的患者需要行颈段食管造口术,而 eVAC 组中没有患者需要行颈段食管造口术。
eVAC 治疗食管胃吻合口漏似乎优于其他治疗策略,因为它显著降低了发病率和死亡率。因此,我们建议将 eVAC 作为食管切除术后吻合口漏治疗算法中的一个重要组成部分,特别是在胸内吻合口的患者中。