Leakage after an esophagectomy is associated with significant morbidity and mortality. Early diagnosis and management is required to minimize complications.
Grading of Anastomotic Leak (Esophageal Complications Consensus Group)
Type
localized defect; no change in therapy OR dietary modification OR medically managed
1
localized defect requiring an intervention but not surgery
2
localized defect requiring surgery
3
There probably should be additional grades for (1) more than localized defect and (2) complete failure of the anastomosis.
Complications of anastomotic leakage:
(1) mediastinitis
(2) sepsis
(3) acute respiratory distress syndrome
(4) disability with poor quality of life
Risk factors for leakage:
(1) type of surgery (highest with minimally invasive esophagectomy)
(2) smoking
(3) preoperative corticosteroid use
(4) ischemia at the anastomosis and/or arteriosclerosis and/or poor vascularity
(5) surgeon's expertise
(6) intraoperative hypotension
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