Accurate Drainage for Intrathoracic Anastomotic Leakage after Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LINHai-ping ¹ , LIPing ² , CHIJia-chang ² , LIANGEr-kang ¹ ,  YEQing ¹ , ZHAOXiao-jing ¹ , CAOZi-ang ¹

1. Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R.China;
2. Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R.China;

Corresponding author：

YEQing, Email: yeqing1@hotmail.com

Keywords：

Esophageal carcinoma; Anastomotic leakage; Drainage

DOI：

10.7507/1007-4848.20160138

Video：

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Objective To explore an effective and minimal invasive drainage procedure for intrathoracic anastomotic leakage after esophagectomy. Method A total of 14 patients (10 males and 4 females, aged 48 to 70 years) with encapsulated effusion due to thoracic anastomotic leakage after esophagectomy were performed accurate thoracic drainage which was guided by ultrasonography in Renji Hospital from January 2012 through December 2014. The J shape flexible catheter was placed into the effusion cavity near the leakage. Gasric drainage and enteral nutrition support were conducted as well. Result All the patients with leakage healed smoothly. The hospital stay was 27 to 94 days. Time of drainage was 17 to 89 days. The drainage volume was 5-260 ml per day. No complication related to drainage occurred. Conclusion Placing the J shape flexible catheter for plural drainage guided by ultrasonography or chest CT scan is a desirable and less injured therapy for intrathoracic leakage after esophagectomy.

Citation： LINHai-ping, LIPing, CHIJia-chang, LIANGEr-kang, YEQing, ZHAOXiao-jing, CAOZi-ang. Accurate Drainage for Intrathoracic Anastomotic Leakage after Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(6): 577-580. doi: 10.7507/1007-4848.20160138 Copy

1.	Markar SR, Schmidt H, Kunz S, et al. Evolution of standardized clinical pathways: refining multidisciplinary care and process to improve outcomes of the surgical treatment of esophageal cancer. J Gastrointest Surg, 2014, 18(7): 1238-1446.
2.	Markar S, Gronnier C, Duhamel A, et al. Pattern of postoperative mortality after esophageal cancer resection according to center volume: results from a large European multicenter study. Ann Surg Oncol, 2015, 22(8): 2615-2623.
3.	Rutegard M, Lagergren P, Rouvelas I, et al. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol, 2012, 19(1): 99-103.
4.	Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
5.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimallyinvasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
6.	Weidenhagen R, Hartl WH, Gruetzner KU, et al. Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg, 2010, 90(5): 1674-1681.
7.	Brangewitz M, Voigtlander T, Helfritz FA, et al. Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy, 2013, 45(6): 433-438.
8.	Kotzampassakis N, Christodoulou M, Krueger T, et al. Esophageal leaks repaired by a muscle onlay approach in the presence of mediastinal sepsis. Ann Thorac Surg, 2009, 88(3): 966-972.
9.	van der Schaaf M, Lagergren J, Lagergren P, et al. Persisting symptoms after intrathoracic anastomotic leak following oesophagectomy for cancer. Br J Surg, 2012, 99(1): 95-99.
10.	Lee DH, Kim HR, Kim SR, et al. Comparison of clinical outcomes after conservative and surgical treatment of isolated anastomotic leaks after esophagectomy for esophageal cancer. Dis Esophagus, 2013, 26(6): 609-615.
11.	Guo J, Chu X, Liu Y, Zhou N, et al. Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy. World J Surg Oncol, 2014, 29(1): 402-408.
12.	D’Cunha J, Rueth NM, Groth SS, et al. Esophageal stents for anastomotic leaks and perforations. J Thorac Cardiovasc Surg, 2011, 142(1): 39-46.
13.	孙志勇, 富皓白, 曹子昂, 等. 带膜食管支架置入治疗食管癌术后胸内食管吻合口瘘. 中国胸心血管外科临床杂志, 2012, 19(3): 334-335.
14.	朱青松, 章焱周, 吕剑剑, 等. 瘘腔外引流治疗胃食管吻合口瘘. 中国胸心血管外科临床杂志, 2012, 19(3): 336-338.
15.	Jiang F, Yu MF, Ren BH, et al. Nasogastric placement of sump tube through the leak for the treatment of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. J Surg Res, 2011, 171(2): 448-451.
16.	Chen KN. Managing complications I: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis, 2014, 6(Suppl 3): S355-S363.
17.	Yin G, Xu Q, Chen S, et al. Fluoroscopically guided three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage. Korean J Radiol, 2012, 13(1): 182-188.
18.	Liu YN, Yan Y, Li SJ, et al. Reliable management of post-esophagectomy anastomotic fistula with endoscopic trans-fistula negative pressure drainage. World J Surg Oncol, 2014, 30(12): 240.
19.	Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg, 2014, 208(4): 536-543.
20.	Raymond D. Complications of esophagectomy. Surg Clin North Am, 2012, 92(5): 1299-1313.

1. Markar SR, Schmidt H, Kunz S, et al. Evolution of standardized clinical pathways: refining multidisciplinary care and process to improve outcomes of the surgical treatment of esophageal cancer. J Gastrointest Surg, 2014, 18(7): 1238-1446.
2. Markar S, Gronnier C, Duhamel A, et al. Pattern of postoperative mortality after esophageal cancer resection according to center volume: results from a large European multicenter study. Ann Surg Oncol, 2015, 22(8): 2615-2623.
3. Rutegard M, Lagergren P, Rouvelas I, et al. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol, 2012, 19(1): 99-103.
4. Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
5. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimallyinvasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
6. Weidenhagen R, Hartl WH, Gruetzner KU, et al. Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy. Ann Thorac Surg, 2010, 90(5): 1674-1681.
7. Brangewitz M, Voigtlander T, Helfritz FA, et al. Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy, 2013, 45(6): 433-438.
8. Kotzampassakis N, Christodoulou M, Krueger T, et al. Esophageal leaks repaired by a muscle onlay approach in the presence of mediastinal sepsis. Ann Thorac Surg, 2009, 88(3): 966-972.
9. van der Schaaf M, Lagergren J, Lagergren P, et al. Persisting symptoms after intrathoracic anastomotic leak following oesophagectomy for cancer. Br J Surg, 2012, 99(1): 95-99.
10. Lee DH, Kim HR, Kim SR, et al. Comparison of clinical outcomes after conservative and surgical treatment of isolated anastomotic leaks after esophagectomy for esophageal cancer. Dis Esophagus, 2013, 26(6): 609-615.
11. Guo J, Chu X, Liu Y, Zhou N, et al. Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy. World J Surg Oncol, 2014, 29(1): 402-408.
12. D’Cunha J, Rueth NM, Groth SS, et al. Esophageal stents for anastomotic leaks and perforations. J Thorac Cardiovasc Surg, 2011, 142(1): 39-46.
13. 孙志勇, 富皓白, 曹子昂, 等. 带膜食管支架置入治疗食管癌术后胸内食管吻合口瘘. 中国胸心血管外科临床杂志, 2012, 19(3): 334-335.
14. 朱青松, 章焱周, 吕剑剑, 等. 瘘腔外引流治疗胃食管吻合口瘘. 中国胸心血管外科临床杂志, 2012, 19(3): 336-338.
15. Jiang F, Yu MF, Ren BH, et al. Nasogastric placement of sump tube through the leak for the treatment of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. J Surg Res, 2011, 171(2): 448-451.
16. Chen KN. Managing complications I: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis, 2014, 6(Suppl 3): S355-S363.
17. Yin G, Xu Q, Chen S, et al. Fluoroscopically guided three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage. Korean J Radiol, 2012, 13(1): 182-188.
18. Liu YN, Yan Y, Li SJ, et al. Reliable management of post-esophagectomy anastomotic fistula with endoscopic trans-fistula negative pressure drainage. World J Surg Oncol, 2014, 30(12): 240.
19. Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg, 2014, 208(4): 536-543.
20. Raymond D. Complications of esophagectomy. Surg Clin North Am, 2012, 92(5): 1299-1313.

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