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Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study

2023; Oxford University Press; Volume: 110; Issue: 7 Linguagem: Inglês

10.1093/bjs/znad123

1365-2168

Sander Ubels, Moniek Verstegen, Bastiaan Klarenbeek, Stefan A.W. Bouwense, Mark I. van Berge Henegouwen, Freek Daams, Marc J. van Det, Ewen A. Griffiths, Jan Willem Haveman, Joos Heisterkamp, Grard A. P. Nieuwenhuijzen, Fatih Polat, Jeroen Schouten, Peter D. Siersema, Pritam Singh, Bas P. L. Wijnhoven, Gerjon Hannink, Frans van Workum, Camiel Rosman, Eric Matthée, Cettela A.M. Slootmans, Gijs Ultee, Suzanne S. Gisbertz, Wietse J. Eshuis, Marianne C. Kalff, Minke L. Feenstra, Donald L. van der Peet, Wessel T. Stam, Boudewijn van Etten, Floris B. Poelmann, Nienke Vuurberg, Jan Willem van den Berg, Ingrid S. Martijnse, R M Matthijsen, Misha Luyer, Wout Curvers, Tom Nieuwenhuijzen, Annick E. Taselaar, Ewout A. Kouwenhoven, Merel Lubbers, Meindert N. Sosef, Frederik Lecot, Tessa C. M. Geraedts, Stijn van Esser, Jan Willem T. Dekker, F. van den Wildenberg, Wendy Kelder, Merel Lubbers, Peter C. Baas, Job W A de Haas, Henk H. Hartgrink, Renu R. Bahadoer, Johanna W. van Sandick, Koen J. Hartemink, Xander Veenhof, Hein B.A.C. Stockmann, Burak Görgec, Pepijn D. Weeder, Marinus J. Wiezer, Charlotte M. S. Genders, Eric J.T. Belt, Bjørn Blomberg, Peter van Duijvendijk, Linda Claassen, David Reetz, Pascal Steenvoorde, W. J. B. Mastboom, Henk Jan Klein Ganseij, Annette D van Dalsen, Annalie Joldersma, Marije Zwakman, R.P. Groenendijk, Mahsa Montazeri, Stuart Mercer, Benjamin Knight, Gijs van Boxel, Richard McGregor, Richard J. E. Skipworth, Cristina Frattini, Alice Bradley, Magnus Nilsson, Masaru Hayami, Biying Huang, James Bundred, Richard Evans, Peter Grimminger, Pieter C. van der Sluis, Eren Uzun, J. Saunders, Elena Theophilidou, Zubair Khanzada, Jessie A. Elliott, Jeroen E. H. Ponten, Sinéad King, John V. Reynolds, Bruno Sgromo, Khalid Akbari, Samar Shalaby, Christian A. Gutschow, Henner Schmidt, Diana Vetter, Krishna Moorthy, M A H Ibrahim, Grigorious Christodoulidis, Jari Räsänen, Juha Kauppi, Henna Söderström, Renol Koshy, Dimitrios K. Manatakis, Dimitrios P. Korkolis, Dimitrios Balalis, Aliki Rompu, Bilal Alkhaffaf, Mohamed Alasmar, Moaad Arebi, Guillaume Piessen, Frederiek Nuytens, Sébastien Degisors, Ahmed Ahmed, Alex Boddy, Suraj Gandhi, Oluwatomini Fashina, Elke Van Daele, Piet Pattyn, William B. Robb, Mayilone Arumugasamy, Mohammed Al Azzawi, Jack Whooley, Elif Çolak, Engin Aybar, Ahmet C. Sari, M S Uyanik, Ahmet Burak Çiftçi, Raza Sayyed, Bushra Ayub, Ghulam Murtaza, Aniqa Saeed, Priyanka Ramesh, Alexandros Charalabopoulos, Theodore Liakakos, Dimitriοs Schizas, Efstratia Baili, Alkistis Kapelouzou, Michele Valmasoni, Elisa Sefora Pierobon, Giovanni Capovilla, Stefano Merigliano, S Constantinoiu, Rodica Bîrlă, Florin Achim, C Roşianu, Petre Hoară, Raúl Guevara Castro, Andrés Felipe Salcedo, Ionuț Negoi, Valentina Madalina Negoita, Cezar Ciubotaru, Bogdan Stoica, Sorin Hostiuc, Nicola Colucci, Stefan Mönig, Charles‐Henri Wassmer, Jérémy Meyer, Flávio Roberto Takeda, Rubens Antônio Aissar Sallum, Ulysses Ribeiro, Ivan Cecconello, Enrique Toledo, Maria Soledad Trugeda, María José Fernández, Carolina Gil, Sonia Castanedo, Arda Işık, Eray Kurnaz, José Flávio Videira, Mariana Peyroteo, Rita Canotilho, Jacopo Weindelmayer, Simone Giacopuzzi, Carlo Alberto De Pasqual, Marcos Bruna, Fernando Mingol, Javier Vaque, Carla Pérez, Alexander W. Phillips, Jakub Chmelo, Joshua Brown, Renol Koshy, Laura E. Han, James Gossage, Andrew Davies, Cara Baker, Mark Kelly, Mohamed Saad, Daniele Bernardi, Luigi Bonavina, Emanuele Asti, Claudio Riva, Rosa Scaramuzzo, Muhammed Elhadi, Hazem Ahmed, Muhammed Elhadi, Faruk Ali Elnagar, Ahmed Msherghi, Vanessa Wills, Cassidy Campbell, Marisol Perez Cerdeira, Scott D. Whiting, Neil D. Merrett, A. Das, Christos Apostolou, Aldenb Lorenzo, Fabiana Sousa, José Barbosa, Vítor Devezas, Elisabete Barbosa, Cristina Fernandes, Garett Smith, Edward Y Li, Nazim Bhimani, Priscilla H. Chan, Krishna Kotecha, Michael W. Hii, Salena Ward, Maryann Johnson, Matthew Read, Lynn Chong, Michael Hollands, Matthew G. R. Allaway, A. J. Richardson, Emma Johnston, Andy Chen, Harsh Kanhere, Shalvin Prasad, Patrick McQuillan, Tim Surman, Markus Trochsler, W A Schofield, Syeda Khadijah Ahmed, Jessica L. Reid, M C Harris, Sivakumar Gananadha, Jessica Farrant, Nicole Hertzog Rodrigues, James Fergusson, Andrew Hindmarsh, Zeeshan Afzal, Peter Safranek, Vijay Sujendran, Siobhán Rooney, Carlos Loureiro, Saioa Leturio Fernández, Ismael Díez del Val, Shameen Jaunoo, Lauren Kennedy, Ahmad Hussain, Dimitrios Theodorou, Tania Triantafyllou, Charalampos Theodoropoulos, Theodora Palyvou, Muhammed Elhadi, Fatima Abdullah Ben Taher, Mustafa Ekheel, Ahmed Msherghi,

Gastric Cancer Management and Outcomes

Abstract Background Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. Methods A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011–2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. Results Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. −1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. −1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. −21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. Conclusion Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.