Esophageal anastomotic leak does not affect ability to receive adjuvant treatment

• Published in: Journal of surgical oncology Vol. 111; no. 7; pp. 855 - 861
• Main Authors: Martin, Robert C.G., Farmer, Russell W., Hill, R. Charles St, McMasters, Kelly M., Scoggins, Charles R.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-06-2015; Wiley Subscription Services, Inc
• Subjects: Anastomosis, Surgical - adverse effects; Anastomotic Leak - diagnosis; Anastomotic Leak - etiology; Anastomotic Leak - mortality; Chemotherapy, Adjuvant; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Female; Follow-Up Studies; Humans; Male; Medical treatment; Middle Aged; Morbidity; Mortality; Neoplasm Staging; Prognosis; Prospective Studies; Quality of Life; Radiotherapy, Adjuvant; Risk Factors; Survival Rate
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.23902

Background
Esophageal anastomotic leak is associated with high morbidity and mortality and potentially lethal if not recognized promptly and treated aggressively. While many studies have attempted to delineate the surgical techniques associated with lower rates of anastomotic leak, few have attempted to determine its long term effects on adjuvant therapy and patient quality of life.
Methods
We reviewed our prospective 350 patient esophageal‐gastric database and found 194 esophageal anastomoses performed from 1994 to 2013. Leaks were classified based on timing, severity, and location. We then compared their postoperative courses of adjuvant treatment, morbidity/mortality, and quality of life measured by Karnofsky performance status and EORTC score. Statistical correlations were calculated with χ2, T‐test, Kaplain–Meier, ANOVA, and Cox Regression analyses as appropriate.
Results
Of 194 patients receiving esophageal anastomoses for cancer, 35 (18%) developed clinically diagnosed anastomotic leak 27 from esophagogastric and 8 from esophagojejunal. These groups were similar in preoperative history, preoperative staging, and type of tumor. Type of operation and variations in operative technique did not significantly affect leak rate. Patients with a leak were more likely to require intraoperative transfusion (47.1% vs. 24.1%, P = 0.013). As expected, they had a greater prevalence of perioperative complications to include pneumonia (38.6% vs. 16.3%, P = 0.001), pulmonary embolus (11.3% vs. 4.3%, P = 0.043), ileus (11.4% vs. 1.6%, P = 0.006%), empyema (11.4% vs. 0%, P > 0.001), and catheter related blood stream infections (8.6% vs. 0%, P = 0.001). Despite this increase in perioperative morbidity, there was no statistically significant difference in 90 day peri‐operative mortality (2.8% vs. 2.3%) with similar ability to receive adjuvant therapy (38.6% vs. 48.0%, P = 0.303), quality of life scores (93.2 vs. 93.1, P = 0.9), and survival at 12 months (93% vs. 94%, P = 0.3).
Conclusion
Anastomotic leak after oncologic resection does not preclude adjuvant therapy and, when managed appropriately, does not affect long term performance status or survival. J. Surg. Oncol. 2015 111:855–861. © 2014 Wiley Periodicals, Inc.