Variations in treatment of an anastomotic leakage after Ivor Lewis Esophagectomy

Background: Anastomotic Leakage (AL) after Ivor Lewis Esophagectomy (ILE) is a severe complication that often needs immediate treatment. However, there is no consensus on the optimal treatment. The aim of this study was to describe the outcomes of the different treatment options in patients with either contained or uncontained AL after ILE. Methods: A retrospective analysis was performed on patients that developed AL after ILE in three high volume hospitals. Treatment was based on local preference. Endoscopic and surgical treatment were compared for patients with either contained (leakage confined to the mediastinum) or uncontained AL (leakage with intrapleural manifestations). Results: In total, 73 patients with an AL were included. A contained leak was observed in 39 patients. Twenty-five patients (64%) underwent an endoscopic approach that was successful in 19 patients (76%); fourteen patients (36%) underwent a surgical approach that was successful in 11 patients (79%). Significantly more patients were (re)admitted to the ICU in the surgical group; other outcomes were similar. An uncontained leak was observed in 34 patients. Endoscopic treatment was chosen in 14 patients (41%) and was successful in 10 patients (71%). A surgical approach was performed in 20 patients (59%) and was successful in 12 patients (60%). (Re) admission rate to the ICU was significantly higher in the surgical group, other outcomes were similar. Conclusions: This study demonstrates that there is high variability in the treatment of AL after esophagectomy. Surgical and endoscopic techniques are both successfully used for patients with either contained or uncontained leakages. However, more research is necessary before a treatment algorithm can be developed.