Mortality secondary to esophageal anastomotic leak

Esophageal anastomotic leak is a potentially life threatening complication of esophagectomy and esophagogastrectomy. We reviewed our experience with this complication and tried to identify factors predictive of mortality after esophageal anastomotic leak.

Records of patients undergoing esophagectomy and esophagogastrectomy for benign or malignant disease over a 10-year period (1989-1999), who developed esophageal anastomotic leaks, were reviewed.

Three-hundred and seven patients underwent esophagectomy or esophagogastrectomy. Twenty-three (7.5%) developed esophageal anastomotic leaks. Eight of these patients (35%) died. Four of 23 (17%) patients had seemingly normal postoperative contrast studies. Factors potentially predictive of death included age (died, 72.8+/-8.3 years; survived, 65.3+/-8.8 years; p=0.063), location of anastomosis (cervical, 3/9 died; thoracic, 5/14 died; p=0.91), leak presentation (clinical, 6/12 died; contrast study, 2/11 died; p=0.11), time of leak (<7 days, 3/5 died; > or =7 days, 5/18 died; p=0.18), presence of gastric necrosis (necrosis, 3/3 died; no necrosis, 5/20 died; p=0.019), and treatment (surgical, 4/4 died; conservative, 4/19 died; p=0.005).

Postoperative esophageal anastomotic leaks prove fatal in a significant number of cases. The lethal potential of cervical anastomotic leaks should not be underestimated. Gastric necrosis is an important predictor of subsequent death. Advanced age, early postoperative (<7 days) leakage, and clinically apparent signs of leakage may be predictive of death but these factors did not reach statistical significance in our study. Surgical treatment of esophageal anastomotic leaks is associated with subsequent death, but this relationship is unlikely to be causal; severely ill patients tend to be treated surgically.