A retrospective comparative study on the short-term and long-term efficacy of different treatments for anastomotic leakage after esophagectomy

Abstract

This study aims to evaluate the short-term and long-term efficacy of various treatment modalities for anastomotic leakage following esophagectomy. We conducted a retrospective analysis of patients diagnosed with anastomotic leakage after esophageal surgery from January 2020 to December 2023 at our institution. A total of 385 patients underwent esophagectomy, with 30 patients with anastomotic leakage enrolled. Patients were stratified into 2 groups based on the treatment approach: a control group receiving conservative management (n = 15), and an observation group (n = 15), which underwent endoscopic or surgical interventions. We collected comprehensive patient data, compared clinical outcomes including our institutional clinical efficacy score, evaluated fistula closure rates, and documented the incidence of postoperative complications. The Dysphagia Handicap Index questionnaire was utilized to assess the impact of dysphagia on patients' quality of life. No significant differences were observed in the baseline surgical and demographic characteristics of the 2 groups (P > .05). At 3 and 6 months post-treatment, the clinical treatment effect scores for the observation group (5.67 ± 0.72 and 8.33 ± 1.63) were significantly higher than those of the control group (4.73 ± 0.88 and 6.27 ± 1.03) (P < .001). Additionally, the effective fistula closure rate was markedly greater in the observation group (73.33%) compared to the control group (53.33%) (P < .05). There was no significant difference in the incidence of complications between the 2 groups (P > .05). Furthermore, the Dysphagia Handicap Index scores, functional, emotional, and physical, were significantly lower in the observation group than in the control group (P < .001). Subgroup analysis showed effective closure rates of 75.0% for stenting, 80.0% for endoscopic vacuum-assisted closure, and 50.0% for reoperation. Endoscopic or surgical interventions demonstrate a significant improvement in fistula closure rates and treatment efficacy in the short term compared to traditional conservative management. Long-term follow-up indicates that these interventions enhance swallowing function and markedly improve quality of life, alleviating emotional and physiological burdens. Importantly, although these approaches are invasive, the complication rates did not increase, underscoring their safety in this cohort.

Keywords: anastomotic fistula; conservative management; endoscopic intervention; esophagectomy; quality of life; short-term and long-term efficacy.

Figure 1.

Clinical treatment effect score. This figure illustrates the comparative clinical treatment effect scores between the observation group and the control group at 3 months and 6 months post-treatment. The observation group consistently demonstrated significantly higher treatment effect scores compared to the control group, indicating a more favorable clinical response to the treatment methods utilized in the observation group (P < .001). Asterisks indicate a statistically significant difference.

Figure 2.

Dysphagia Handicap Index (DHI) score. This figure presents the DHI scores across 3 domains, functional, emotional, and physical, reflecting the impact of dysphagia on patients’ quality of life at 6 months post-treatment. The observation group exhibited significantly lower DHI scores in all domains compared to the control group, suggesting that patients in the observation group experienced a reduced burden of dysphagia and its associated challenges in daily living (P < .001). Asterisks indicate a statistically significant difference.