Outcome of Self-Expanding Metal Stents in the Treatment of Anastomotic Leaks After Ivor Lewis Esophagectomy

• Published in: World journal of surgery 2019-03, Vol.43 (3), p.862-869
• Main Authors: Plum, Patrick Sven, Herbold, Till, Berlth, Felix, Christ, Hildegard, Alakus, Hakan, Bludau, Marc, Chang, De-Hua, Bruns, Christiane Josephine, Hölscher, Arnulf Heinrich, Chon, Seung-Hun
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cancer; Cardiac Surgery; Complications; Demographics; Dislocation; Dislocations; Esophagus; Fistulae; Gastrointestinal surgery; General Surgery; Implants; Leakage; Medicine; Medicine & Public Health; Metals; Original Scientific Report (including Papers Presented at Surgical Conferences); Patients; Perforation; Risk analysis; Risk factors; Sealing; Stenosis; Stents; Success; Surgery; Surgical implants; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4832-2

Background Esophageal anastomotic leakages after Ivor Lewis esophagectomy are severe and life-threatening complications. We analyzed the outcome of using self-expanding metal stents (SEMS) in the treatment of postoperative leakage after esophagogastrostomy. Methods Seventy patients with esophageal anastomotic leakage after Ivor Lewis esophagectomy for esophageal cancer who had received SEMS treatment between January 2006 and December 2015 at our clinic were identified in this retrospective study. The patients were analyzed according to demographic characteristics, risk factors, leakage characteristics, stent characteristics, stent-related complications, sealing success rate and mortality. Results Over a 10-year period, 70 patients received SEMS as treatment for postoperative anastomotic leakage after esophagectomy. Technical success of esophageal stenting in anastomotic leakage was achieved in 50 out of 70 cases (71.4%). Sealing success rate was 70% ( n  = 49) with a median treatment of 28 days (range 7–87). In 20 patients (28.6%), stent-related complications, such as stenosis, dislocation, leakage persistence, perforation or esophagotracheal fistula occurred after the SEMS treatment. Sixty-one patients (87.1%) survived SEMS treatment of esophagogastric anastomotic leakage. Mean follow-up for all patients was 38 months (IQR 10–76), and no significant difference was found in a comparison of the long-term survival rate between patients with successful and unsuccessful SEMS treatment. Conclusions The management of esophageal anastomotic leaks after Ivor Lewis esophagectomy with SEMS is effective, safe and technically feasible. Aggressive non-surgical management should be considered when developing a treatment plan for stenting.