Diagnosis and management of anastomotic leaks after esophagectomy

Complications following esophagectomy significantly affect outcomes, including perioperative mortality, costs, and survival. Anastomotic leak remains one of the most serious complications, and early recognition and appropriate initial treatment are essential.

Mortality associated with esophageal leaks is decreasing, due in part to the increased use of CT scans and endoscopy for diagnosis. Endoscopic and interventional radiology techniques are being increasingly applied, but appropriate patient selection is important. Removable esophageal stents can be utilized successfully in a significant proportion of patients with limited anastomotic defects.

It is critically important to differentiate between leaks and conduit necrosis. Endoscopic examination is the best method for making this assessment. Surgeons should become familiar with the expanding options for endoscopic assessment and treatment of esophageal anastomotic leaks.