Central Surgical AssociationImpact of anastomotic leak on outcomes after transhiatal esophagectomy
Section snippets
Patients
Approval for this study was provided by the Institutional Review Board of the University of Pittsburgh, and individual patient consent was waived given the retrospective nature of the analysis. We performed a review of 235 consecutive patients who underwent transhiatal esophagectomy for pathologically confirmed cancer at the University of Pittsburgh from 2001 to 2009. The patients were identified from the billing records of the Heart, Lung and Esophageal Surgery Institute as well as the Cancer
Patient and tumor characteristics
Patient and tumor characteristics are summarized in Table I. The mean age for the entire cohort was 65 years. The male:female ratio was 180:55. Adenocarcinoma was the most commonly encountered tumor (81%), followed by squamous cell carcinoma (16%). Neoadjuvant therapy was employed in 37 (16%) of patients. No significant differences were found in age, preoperative patient co-morbidities, histology, or use of neoadjuvant therapy between patients who developed a leak and those with no leak.
Discussion
Although anastomotic leaks represent one of the most common and important major complications after esophagectomy, there is no established consensus regarding what defines a leak. In fact, less than 50% of published series include a clear definition of what constitutes an anastomotic leak.15 The reported incidence of anastomotic leak correspondingly varies widely, averaging 10–15% in the largest series (Table III).4, 16, 17, 18, 19 Some authors define a leak based on radiographic findings,
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2020, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Anastomotic leak is defined as oral secretions or contrast extravasation at the anastomotic site and are graded using the Pittsburgh Leak Scale. ( Class 0 = no leak; Class 1 = radiographic leak only, no intervention; Class 2 = leak [<10% of circumference] requiring cervical and/or percutaneous drainage; Class 3 = disruption of anastomosis [10%-50% circumference] with perianastomotic abscess and associated pleural or mediastinal collection requiring video-assisted thoracoscopic surgery) or thoracotomy; and Class 4 = gastric tip necrosis with anastomotic separation [>50% circumference]).11 Short-term mortality was defined as in-hospital death or death within 30-days after the operation.
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