Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study
Authors: Ubels Sander , Verstegen Moniek H P , Klarenbeek Bastiaan R , Bouwense Stefan , van Berge Henegouwen Mark I , Daams Freek , van Det Marc J , Griffiths Ewen A , Haveman Jan Willem , Heisterkamp Joos , Nieuwenhuijzen Grard , Polat Fatih , Schouten Jeroen , Siersema Peter D , Singh Pritam , Wijnhoven Bas , Hannink Gerjon , van Workum Frans , Rosman Camiel ,   the TENTACLE—Esophagus Collaborative Group, Matthée Eric , Slootmans Cettela A M , Ultee Gijs , Gisbertz Suzanne S , Eshuis Wietse J , Kalff Marianne C , Feenstra Minke L , van der Peet Donald L , Stam Wessel T , Van Etten Boudewijn , Poelmann Floris , Vuurberg Nienke , van den Berg Jan Willem , Martijnse Ingrid S , Matthijsen Robert M , Luyer Misha , Curvers Wout , Nieuwenhuijzen Tom , Taselaar Annick E , Kouwenhoven Ewout A , Lubbers Merel , Sosef Meindert , Lecot Frederik , Geraedts Tessa C M , van Esser Stijn , Dekker Jan Willem T , van den Wildenberg Frits , Kelder Wendy , Lubbers Merel , Baas Peter C , de Haas Job W A , Hartgrink Henk H , Bahadoer Renu R , van Sandick Johanna W , Hartemink Koen J , Veenhof Xander , Stockmann Hein , Gorgec Burak , Weeder Pepijn , Wiezer Marinus J , Genders Charlotte M S , Belt Eric , Blomberg Bjorn , van Duijvendijk Peter , Claassen Linda , Reetz David , Steenvoorde Pascal , Mastboom Walter , Klein Ganseij Henk Jan , van Dalsen Annette D , Joldersma Annalie , Zwakman Marije , Groenendijk Richard P R , Montazeri Mahsa , Mercer Stuart , Knight Benjamin , van boxel Gijs , McGregor Richard J , Skipworth Richard J E , Frattini Cristina , Bradley Alice , Nilsson Magnus , Hayami Masaru , Huang Biying , Bundred James , Evans Richard , Grimminger Peter P , van der Sluis Pieter C , Eren Uzun , Saunders John , Theophilidou Elena , Khanzada Zubair , Elliott Jessie A , Ponten Jeroen E H , King Sinead , Reynolds John V , Sgromo Bruno , Akbari Khalid , Shalaby Samar , Gutschow Christian A , Schmidt Henner , Vetter Diana , Moorthy Krishna , Ibrahim Mohamed A H , Christodoulidis Grigorious , Räsänen Jari V , Kauppi Juha , Söderström Henna , Koshy Renol , Manatakis Dimitrios K , Korkolis Dimitrios P , Balalis Dimitrios , Rompu Aliki , Alkhaffaf Bilal , Alasmar Mohamed , Arebi Moaad , Piessen Guillaume , Nuytens Frederiek , Degisors Sebastien , Ahmed Ahmed , Boddy Alex , Gandhi Suraj , Fashina Oluwatomini , Van Daele Elke , Pattyn Piet , Robb William B , Arumugasamy Mayilone , Al Azzawi Mohammed , Whooley Jack , Colak Elif , Aybar Engin , Sari Ahmet C , Uyanik Mustafa S , Ciftci Ahmet B , Sayyed Raza , Ayub Bushra , Murtaza Ghulam , Saeed Aniqa , Ramesh Priyanka , Charalabopoulos Alexandros , Liakakos Theodore , Schizas Dimitrios , Baili Efstratia , Kapelouzou Alkistis , Valmasoni Michele , Pierobon Elisa Sefora , Capovilla Giovanni , Merigliano Stefano , Constantinoiu Silviu , Birla Rodica , Achim Florin , Rosianu Cristian Gelu , Hoara Petre , Castro Raúl Guevara , Salcedo Andrés Felipe , Negoi Ionut , Negoita Valentina M , Ciubotaru Cezar , Stoica Bogdan , Hostiuc Sorin , Colucci Nicola , Mönig Stefan P , Wassmer Charles-Henri , Meyer Jeremy , Takeda Flavio Roberto , Aissar Sallum Rubens Antonio , Ribeiro Ulysses , Cecconello Ivan , Toledo Enrique , Trugeda Maria Soledad , José Fernández María , Gil Carolina , Castanedo Sonia , Isik Arda , Kurnaz Eray , Videira José Flávio , Peyroteo Mariana , Canotilho Rita , Weindelmayer Jacopo , Giacopuzzi Simone , De Pasqual Carlo Alberto , Bruna Marcos , Mingol Fernando , Vaque Javier , Pérez Carla , Phillips Alexander W , Chmelo Jakub , Brown Joshua , Koshy Renol , Han Laura E , Gossage James A , Davies Andrew R , Baker Cara R , Kelly Mark , Saad Mohamed , Bernardi Daniele , Bonavina Luigi , Asti Emanuele , Riva Carlo , Scaramuzzo Rosa , Elhadi Muhammed , Abdelkarem Ahmed Hazem , Elhadi Ahmed , Ali Elnagar Faruk , Msherghi Ahmed A A , Wills Vanessa , Campbell Cassidy , Cerdeira Marisol Perez , Whiting Scott , Merrett Neil , Das Amitabha , Apostolou Christos , Lorenzo Aldenb , Sousa Fabiana , Barbosa José Adelino , Devezas Vítor , Barbosa Elisabete , Fernandes Cristina , Smith Garett , Li Edward Y , Bhimani Nazim , Chan Priscilla , Kotecha Krishna , Hii Michael W , Ward Salena M , Johnson MaryAnn , Read Matthew , Chong Lynn , Hollands Michael J , Allaway Matthew , Richardson Arthur , Johnston Emma , Chen Andy Z L , Kanhere Harsh , Prasad Shalvin , McQuillan Patrick , Surman Tim , Trochsler Markus I , Schofield W A , Khadijah Ahmed Syeda , Reid Jessica L , Harris Mark C , Gananadha Sivakumar , Farrant Jessica , Rodrigues Nicole , Fergusson James , Hindmarsh Andrew , Afzal Zeeshan , Safranek Peter , Sujendran Vijay , Rooney Siobhan , Loureiro Carlos , Fernández Saioa Leturio , del Val Ismael Díez , Jaunoo Shameen , Kennedy Lauren , Hussain Ahmed , Theodorou Dimitrios , Triantafyllou Tania , Theodoropoulos Charalampos , Palyvou Theodora , Elhadi Muhammed , Ben Taher Fatima Abdullah , Ekheel Mustafa , Msherghi Ahmed A A 
Published: May 2023

Background

Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy.

Methods

A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011–2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders.

Results

Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. −1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. −1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. −21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies.

Conclusion

Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.