Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: Options of treatment

Fabio Carboni, Mario Valle, Orietta Federici, Giovanni Battista Levi Sandri, Ida Camperchioli, Rocco Lapenta, Daniela Assisi, Alfredo Garofalo

Research output: Contribution to journalArticle

Abstract

Background: Esophagojejunal anastomosis leakage after total gastrectomy (TG) for esophagogastric junction (EGJ) adenocarcinoma (ADC) constitutes one of the most serious and sometimes life-threatening complications. Management remains controversial and still challenging. Methods: A total of 198 patients operated for type I and II EGJ ADC were reviewed. Diagnosis of leakage was based on a combination of clinical and radiological findings. It was classified including objective endoscopic and clinical parameters requiring different type of treatment. Results: Anastomotic leakage was diagnosed in 14 patients (7%). Two cases recovered with conservative therapy. Six cases underwent endoscopy with clips placement in 2 and partially covered self-expandable metal stent placement in 4. Other two cases underwent reoperation with reconstruction of anastomosis and primary repair respectively. In the last four cases emergency surgery with total esophagectomy and diversion was required. Mortality occurred only in 3 of these patients and overall treatment was successful in 11 patients (78.5%). Conclusions: No consensus has been reached on the best method of esophagojejunal anastomosis leakage management and the rate of failure remains significant. Different options of treatment are available but early detection and multidisciplinary approaches are the keys to obtain successful results irrespective of the employed strategy.

Original languageEnglish
Pages (from-to)515-522
Number of pages8
JournalJournal of Gastrointestinal Oncology
Volume7
Issue number4
DOIs
Publication statusPublished - Aug 1 2016

Keywords

  • Diagnosis
  • Esophagogastric junction adenocarcinoma (EGJ ADC)
  • Esophagojejunal anastomosis
  • Leakage
  • Treatment

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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