Complications in Esophageal Surgery

This thesis describes randomized controlled trials regarding surgical techniques after esophagectomy and the use of the Comprehensive Complication Index

Does Routine Endoscopy or Contrast Swallow Study After Esophagectomy and Gastric Tube Reconstruction Change Patient Management?

Background: Anastomotic leakage is a severe complication after esophagectomy. The objective was to investigate the diagnostic and predictive value of routine contrast swallow study and endoscopy for the detection of anastomotic dehiscence in patients after esophagectomy. Methods: All patients who underwent contrast swallow and/or endoscopy within 7 days after oesophagectomy for cancer between January 2005 and December 2009 were selected from an institutional database. Results: Some 173 patients underwent endoscopy, and 184 patients underwent a contrast swallow study. The sensitivity of endoscopy for anastomotic leakage requiring intervention is 56 %, specificity 41 %, positive predictive value (PPV) 8 %, and negative predictive value (NPV) 95 %. The sensitivity of contrast swallow study for detecting leakage requiring intervention in patients without signs of leakage was 20 %, specificity 20 %, PPV 3 %, and NPV 97 %. Conclusions: In patients without clinical suspicion of leakage, there is no benefit to perform routine examinations

A single blinded randomized controlled trial comparing semi-mechanical with hand-sewn cervical anastomosis after esophagectomy for cancer (SHARE-study)

Objective: The aim was to compare leak rate between hand‐sewn end‐to‐end anastomosis (ETE) and semi‐mechanical anastomosis (SMA) after esophagectomy with gastric tube reconstruction. Background Data: The optimal surgical technique for creation of an anastomosis in the neck after esophagectomy is unclear. Methods: Patients with esophageal cancer undergoing esophagectomy with gastric tube reconstruction and cervical anastomosis were eligible for participation after written informed consent. Patients were randomized in 1:1 ratio. Primary endpoint was anastomotic leak rate defined as external drainage of saliva from the site of the anastomosis or intra‐thoracic manifestation of leak. Secondary endpoints included anastomotic stricture rate at one year follow up, number of endoscopic dilatations, dysphagia‐score, hospital stay, morbidity, and mortality. Patients were blinded for intervention. Results: Between August 2011 and July 2014, 174 patients with esophageal cancer underwent esophagectomy. Ninety‐three patients were randomized to ETE (n = 44) or SMA (n = 49). Anastomotic leak occurred in 9 of 44 patients (20%) in the ETE group and 1