P1.198. Systematic Screening for Anastomotic Leakage After Esophagectomy for Cancer: Lessons Learned From a Retrospective Analysis
TL;DR
Although early diagnosis of AL is key to its successful management, systematic screening could only diagnose patients who were already exhibiting symptoms or signs suggestive of leakage, and screening providing a false sense of security in 81.6% of patients is advocated for a more patient-tailored, targeted approach to screening for AL.
Abstract
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Anastomotic leakage (AL) after esophagectomy for cancer is associated with negative outcomes that could be mitigated by screening and early treatment of the complication. We aimed to assess whether patients with AL diagnosed through systematic radiological screening did already exhibit signs of possible leakage which would have prompted diagnostic testing. Patients undergoing esophagectomy with intrathoracic anastomosis at a tertiary center between 2014 and 2021 were included. Systematic screening consisted of contrast swallow or computed tomography (CT) with per-oral contrast on postoperative days (POD) 4–5. Patients with positive screening were assessed for following signs suggestive of AL from POD 0 to POD 5: C-reactive protein (CRP) ≥ 300mg/L, new-onset leukocytosis with white blood cell count ≥ 10*109/L, temperature ≥ 38°C, tachycardia with ≥ 120 bpm, and presence of atrial dysrhythmia. Of 53 patients with intrathoracic AL, 49 (92.5%) underwent systematic screening and 9 (17.0%) were diagnosed at screening (contrast swallow 55.6%, CT 44.4%). In all these patients with positive screening, signs suggestive of AL were already present: elevated CRP in 2 (22%), new-onset leukocytosis in 3 (33.3%), fever in 6 (66.7%), tachycardia in 6 (66.7%), and atrial dysrhythmia in 1 (11.1%). Of note, the 40 (81.6%) patients with negative screening developed AL on median day 9.5 (interquartile range 7-15.25), despite initial screening being negative. Although early diagnosis of AL is key to its successful management, systematic screening could only diagnose patients who were already exhibiting symptoms or signs suggestive of leakage. With day of AL-diagnosis varying strongly in our cohort, and screening providing a false sense of security in 81.6% of patients, these results advocate for a more patient-tailored, targeted approach to screening for AL.