Routine Radiologic Assessment for Anastomotic Leak Is Not Necessary in Asymptomatic Patients After Esophagectomy for Esophageal Cancer

• Published in: Journal of gastrointestinal surgery 2022-02, Vol.26 (2), p.279-285
• Main Authors: Kang, Hansol, Ben-David, Kfir, Sarosi, George A., Thomas, Ryan M.
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical - adverse effects; Anastomotic Leak - diagnostic imaging; Anastomotic Leak - etiology; Asymptomatic; Asymptomatic Diseases; Diagnostic Tests, Routine; Esophageal cancer; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Gastroenterology; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Mortality; Original Article; Patients; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - surgery; Postoperative period; Recovery (Medical); Retrospective Studies; Sensitivity and Specificity; Statistical analysis; Surgery; Surgical anastomosis
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-021-05219-3

Background Anastomotic leaks (AL) are a major source of post-esophagectomy morbidity and patients are often initially asymptomatic. Debate exists on timing and utility of imaging to detect AL post-esophagectomy. We sought to evaluate the efficacy and timing of radiographic AL evaluation in esophageal cancer patients post-esophagectomy. Methods A retrospective database of esophageal cancer patients who underwent esophagectomy at a single institution from 2004 to 2020 was used to determine the utilization, timing, and sensitivity of radiologic testing for AL post-esophagectomy. Results Seventy-six patients were identified of which 37 (49%) had a cervical anastomosis. Sixty-four (84%) underwent 71 “asymptomatic radiographic leak tests” (ARLT), 7 of which had 2 different tests, including: 41 fluoroscopic esophagrams (58%), 18 CT-esophagrams (25%), and 12 upper GI studies (17%). Seventeen patients (22%) developed clinical signs of AL (hemodynamic instability, leukocytosis) and underwent “symptomatic radiographic leak tests” (SRLT) with fluoroscopic esophagram (n = 9, 12%), CT-esophagram (n = 7, 9%), or upper GI study (n = 1, 1%). ARLT and SRLT were positive in 2/64 (3%) and 17/17 (100%) patients, respectively, for 19 total ALs (25%). Among the 17 SRLT( +) patients, 1 was also ARLT( +), 13 were initially ARLT( −), and 3 were not evaluated by ARLT. The median postoperative day for ARLT and SRLT was 4.0 (IQR 3.0–5.5) and 9.0 days (IQR 6.0–13.0), respectively, with a statistically significant difference (p