TY - JOUR
T1 - Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma
T2 - Options of treatment
AU - Carboni, Fabio
AU - Valle, Mario
AU - Federici, Orietta
AU - Levi Sandri, Giovanni Battista
AU - Camperchioli, Ida
AU - Lapenta, Rocco
AU - Assisi, Daniela
AU - Garofalo, Alfredo
PY - 2016/8/1
Y1 - 2016/8/1
N2 - 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.
AB - 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.
KW - Diagnosis
KW - Esophagogastric junction adenocarcinoma (EGJ ADC)
KW - Esophagojejunal anastomosis
KW - Leakage
KW - Treatment
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U2 - 10.21037/jgo.2016.06.02
DO - 10.21037/jgo.2016.06.02
M3 - Article
AN - SCOPUS:84995757521
VL - 7
SP - 515
EP - 522
JO - Journal of Gastrointestinal Oncology
JF - Journal of Gastrointestinal Oncology
SN - 2078-6891
IS - 4
ER -