Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug;7(4):515-22.
doi: 10.21037/jgo.2016.06.02.

Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment

Fabio Carboni  1 , Mario Valle  1 , Orietta Federici  1 , Giovanni Battista Levi Sandri  1 , Ida Camperchioli  1 , Rocco Lapenta  2 , Daniela Assisi  2 , Alfredo Garofalo  1
Affiliations

Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment

Fabio Carboni et al. J Gastrointest Oncol. 2016 Aug.

Abstract

Background: Esophagojejunal anastomosis leakage after total gastrectomy (TG) for esophagogastric junction (EGJ) adenocarcinoma (ADC) constitutes one of the most serious and sometimes life-threatening complications. Management remains controversial and still challenging.

Methods: A total of 198 patients operated for type I and II EGJ ADC were reviewed. Diagnosis of leakage was based on a combination of clinical and radiological findings. It was classified including objective endoscopic and clinical parameters requiring different type of treatment.

Results: Anastomotic leakage was diagnosed in 14 patients (7%). Two cases recovered with conservative therapy. Six cases underwent endoscopy with clips placement in 2 and partially covered self-expandable metal stent placement in 4. Other two cases underwent reoperation with reconstruction of anastomosis and primary repair respectively. In the last four cases emergency surgery with total esophagectomy and diversion was required. Mortality occurred only in 3 of these patients and overall treatment was successful in 11 patients (78.5%).

Conclusions: No consensus has been reached on the best method of esophagojejunal anastomosis leakage management and the rate of failure remains significant. Different options of treatment are available but early detection and multidisciplinary approaches are the keys to obtain successful results irrespective of the employed strategy.

Keywords: Esophagogastric junction adenocarcinoma (EGJ ADC); diagnosis; esophagojejunal anastomosis; leakage; treatment.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Algorithm for diagnosis and treatment of EJAL. EJAL, esophagojejunal anastomotic leakage.
Figure 2
Figure 2
Anastomotic defect treated with endoscopy clip procedure. (A) Abdominal CT scan showing extraluminal contrast leakage at the anastomosis; (B) endoscopic treatment with clips placement; (C) OTSC device: clap placed around the leakage; (D) OTSC device: closure of the leakage. OTSC, Over-The-Scope-Clip.
Figure 3
Figure 3
Anastomotic defect treated with endoscopy stent procedure. (A) Endoscopy showing anastomotic defect; (B) partially covered metal stent placed; (C) radiologic control of stent placement with bilateral percutaneous CT-guided drainage. OTSC, Over-The-Scope-Clip.
Figure 4
Figure 4
Surgical picture of reconstruction. (A) Terminal ileum and right colon transposition; (B) hand-sewn neck anastomosis; (C) postoperative contrast swallow.
See this image and copyright information in PMC

References

    1. Sauvanet A, Mariette C, Thomas P, et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg 2005;201:253-62. 10.1016/j.jamcollsurg.2005.02.002 - DOI - PubMed
    1. Schumacher G, Schmidt SC, Schlechtweg N, et al. Surgical results of patients after esophageal resection or extended gastrectomy for cancer of the esophagogastric junction. Dis Esophagus 2009;22:422-6. 10.1111/j.1442-2050.2008.00923.x - DOI - PubMed
    1. Carboni F, Lorusso R, Santoro R, et al. Adenocarcinoma of the esophagogastric junction: the role of abdominal-transhiatal resection. Ann Surg Oncol 2009;16:304-10. 10.1245/s10434-008-0247-x - DOI - PubMed
    1. Lang H, Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 2000;26:168-71. 10.1053/ejso.1999.0764 - DOI - PubMed
    1. Yoo HM, Lee HH, Shim JH, et al. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol 2011;104:734-40. 10.1002/jso.22045 - DOI - PubMed