Cervical Anastomotic Leak After Esophagectomy: Diagnosis and Management

Abstract Introduction Cervical anastomotic leaks after esophagectomy are still a frequent and severe complication that needs an early diagnosis and an appropriate treatment. The aim of this study was to describe our experience with the management of this complication. Patients and methods Retrospective study (2003–2011) of a consecutive series of 77 patients with a cervical esophagogastric anastomosis, 18 of them (23.3%) presenting a leak. Fistulae were classified into four groups depending on clinical presentation, radiology (esophagogram or CT), surgical findings -in case of re-operation- and, since 2010, endoscopic examination. Type I leaks were an asymptomatic or radiographic leak, Type II had local signs limited to the neck, Type III was associated with respiratory symptoms due to a pleural or mediastinal collection, and Type IV with a systemic disorder secondary to gastric necrosis. Results Four patients (22.2%) were classified as Type I, 8 (44.4%) as Type II, 3 (16.6%) as Type III, and 3 (16.6%) as Type IV. Eight patients were managed conservatively; in 9 a self-expanding stent was used, 5 required a thoracotomy, and one of them (Type IV) died. Leaks were related to a higher associated morbidity (61 versus 30%, P =.019) and a longer hospital stay (median of 28.5 vs 14 days, P =.009). Conclusions Almost one quarter of cervical esophagogastric anastomoses present some kind of anastomotic leak. Although most of them can be treated conservatively or by endoscopy, they are associated with an increase in morbidity and mortality.