Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy |
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Authors: | Werner K H Kauer Hubert J Stein Hans-Joachim Dittler J Rüdiger Siewert |
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Institution: | 1.Department of Surgery SALK,Paracelsus Medizinische Privatuniversit?t Salzburg,Salzburg,Austria;2.Department of Surgery,Klinikum rechts der Isar, Technische Universit?t,München,Germany;3. SALK,Chirurgische Universit?tsklinik,Salzburg,Austria |
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Abstract: | Background In patients with esophagectomy and gastric pull up for esophageal carcinoma anastomotic leaks are a well-known complication
and a major cause of morbidity and mortality.
Objective We evaluated stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy.
Methods 269 patients with esophageal cancer (adenocarcinoma n = 212, squamous cell carcinoma n = 57) had undergone esophagectomy and gastric pull up with an intrathoracic anastomosis between January 1998 and December
2005. A thoracic anastomotic leak was clinically and endoscopically proven in 12 patients (4.5%). Endoscopic insertion of
a self-expanding covered metal stent at the site of the anastomotic leak was performed in 10 patients; two patients were treated
with fibrin glue.
Results Stents were successfully placed in all patients without complications. In all but one patient (n = 9) radiological examination showed complete closure of the leakage. In one patient the stent was endoscopically corrected
and complete closure could be achieved thereafter. The stent could be removed after six weeks in five patients. Stent migration
occurred in four patients. In all but one patient (n = 7) definitive leak occlusion was achieved. Two patients died during their hospital stayfor reasons not related to the stent
placement.
Conclusion Stent implantation in patients with thoracic anastomotic leaks after esophagectomy is an easily available and effective treatment
option with low morbidity, but stent migration does occur. |
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Keywords: | Stent implantation Anastomotic leak Esophagectomy |
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