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Updated: Jun 29, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
The Atypical Presentation and Delayed Timing of Anastomotic Leak in Patients Who Undergo Cytoreducation and
Colin J Rog1, Riom Kwakman2, Charlotte van Schooten1
1Division of Surgical Oncology, Department of Surgery, Swedish Medical Center, Seattle, Washington.
Introduction:
Anastomotic leak (AL) can be a disproportionately devastating complication following cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) due to its effect on both perioperative and oncologic outcomes. Anecdotally, patients who underwent CRS/HIPEC present in an atypically fashion compared to those who undergo non-CRS/HIPEC gastrointestinal surgery, but this has never been rigorously studied.
Methods:
The records for all consecutive patients who underwent CRS/HIPEC with curative intent from prospectively maintained databases at two high-volume centers were retrospectively reviewed. Those who experienced AL were identified and dichotomized into early (
Results:
On median postoperative day (POD) 15, 6.1% of patients experienced AL . Demographics, disease histology, risk factors for AL, receipt of neoadjuvant therapy, and extent of surgery were well-balanced. A higher proportion of small bowel anastomoses leaked in
Conclusions:
Patients who experience AL after CRS/HIPEC often present in an atypical manner compared to those who undergo non-CRS/HIPEC gastrointestinal surgery. These findings are important to any practitioner who encounters CRS/HIPEC patients given that early recognition of AL is crucial to mitigating subsequent sequelae that can negatively impact both short-term perioperative and long-term oncologic outcomes in this uniquely challenging population.
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