PD08.01. Endoscopy on Post-Operative Day 4 After Ivor Lewis Esophagectomy Can Help Predict Anastomotic Outcome
TL;DR
Endoscopy on POD 4 after Ivor Lewis esophagectomy seems safe and can be used to help predict anastomotic outcome, and a combined endoscopy score of <2 on POD 4 predicts uneventful recovery.
Abstract
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Anastomotic leakage (AL) is a serious and potentially life-threatening complication after esophagectomy. Early prediction could enable detection and preventive measures to limit consequences of AL. The aim of this study was to evaluate endoscopy with systematic grading of the anastomosis on postoperative day 4 as a method to predict AL. Seventyseven patients scheduled for Ivor Lewis esophagectomy were prospectively included. Hybrid esophagectomy was performed with a 25 or 28 mm circular stapling device to manufacture the anastomosis. Patients were postoperatively managed according to a standardized enhanced recovery program and examined by endoscopy on post operative day 4 (POD 4). The anastomosis was graded for signs of impaired healing according to a pre-defined protocol, the combined endoscopy score, 0 to 6, based on the appearance on endoscopy at three specific locations: circular anastomosis, longitudinal staple line and top of gastric tube. Outcome was recorded and graded based on the Esophageal Complications Consensus Group (ECCG) definition of AL. Out of 61 patients available for final analysis, 14,7% (n=9) developed AL according to the ECCG definition. Six out of 13 patients (46%) with a combined endoscopy score of ≥ 3, developed AL. Three out of 48 patients (6%) with a combined endoscopy score of ≤2, developed AL. The distribution of endoscopy scores was significantly different between the two groups AL vs. no AL (Pearson p=0.002). The were no differences in clinicopathological characteristics between the groups. No adverse events were recorded with regards to endoscopy on POD 4. Endoscopy on POD 4 after Ivor Lewis esophagectomy seems safe and can be used to help predict anastomotic outcome. A combined endoscopy score of <2 on POD 4 predicts uneventful recovery as 45 out of 48 patients (94%) had normal anastomotic healing. A score of >3 may indicate need for close observation, altered nutrition management and postponed discharge.