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Multicenter Study
. 2019 Jan 21;25(3):356-366.
doi: 10.3748/wjg.v25.i3.356.

Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks

Uberto Fumagalli  1 , Gian Luca Baiocchi  2 , Andrea Celotti  3 , Paolo Parise  4 , Andrea Cossu  4 , Luigi Bonavina  5 , Daniele Bernardi  5 , Giovanni de Manzoni  6 , Jacopo Weindelmayer  6 , Giuseppe Verlato  7 , Stefano Santi  8 , Giovanni Pallabazzer  8 , Nazario Portolani  2 , Maurizio Degiuli  9 , Rossella Reddavid  9 , Stefano de Pascale  3
Affiliations
Multicenter Study

Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks

Uberto Fumagalli et al. World J Gastroenterol. .

Abstract

Background: Mediastinal leakage (ML) is one of the most feared complications of esophagectomy. A standard strategy for its diagnosis and treatment has been difficult to establish because of the great variability in their incidence and mortality rates reported in the existing series.

Aim: To assess the incidence, predictive factors, treatment, and associated mortality rate of mediastinal leakage using the standardized definition of mediastinal leaks recently proposed by the Esophagectomy Complications Consensus Group (ECCG).

Methods: Seven Italian surgical centers (five high-volume, two low-volume) affiliated with the Italian Society for the Study of Esophageal Diseases designed and implemented a retrospective study including all esophagectomies (n = 501) with intrathoracic esophagogastric anastomosis performed from 2014 to 2017. Anastomotic MLs were defined according to the classification recently proposed by the ECCG.

Results: Fifty-nine cases of ML were recorded, yielding an overall incidence of 11.8% (95%CI: 9.1%-14.9%). The surgical approach significantly influenced the occurrence of ML: the proportion of leakage was 10.5% and 9% after open and hybrid esophagectomy (HE), respectively, and doubled (20%) after totally minimally invasive esophagectomy (TMIE) (P = 0.016). No other predictive factors were found. The 30- and 90-d overall mortality rates were 1.4% and 3.2%, respectively; the 30- and 90-d leak-related mortality rates were 5.1% and 10.2%, respectively; the 90-d mortality rates for TMIE and HE were 5.9% and 1.8%, respectively. Endoscopy was the first-line treatment in 49% of ML cases, with the need for retreatment in 17.2% of cases. Surgery was needed in 44.1% of ML cases. Endoscopic treatment had the lowest mortality rate (6.9%). Removal of the gastric tube with stoma formation was necessary in 8 (13.6%) cases.

Conclusion: The incidence of ML after esophagectomy was high mainly in the TMIE group. However, the general and specific (leak-related) mortality rates were low. Early treatment (surgical or endoscopic) of severe leaks is mandatory to limit related mortality.

Keywords: Esophagectomy complications; Mediastinal leak; Minimally invasive esophagectomy; Transthoracic esophagectomy.

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Conflict of interest statement

Conflict-of-interest statement: All authors have received no funding and declare no conflicts of interest in relation to this specific work.

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