Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy
✍ Scribed by Judith Honing; Bareld B. Pultrum; Eric J. van der Jagt; Henk Groen; John Th.M. Plukker
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 69 KB
- Volume
- 100
- Category
- Article
- ISSN
- 0022-4790
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✦ Synopsis
Abstract
Background
To detect anastomotic leakage after esophagectomy in esophageal carcinoma patients, many surgeons perform a radiological contrast examination routinely. The aim of this retrospective study is to determine the clinical relevance of a routine contrast examination after esophagectomy and to evaluate criteria for contrast examination on demand.
Methods
Data were obtained from 211 patients with cancer of the esophagus or gastro‐esophageal junction who underwent an esophagectomy during the period 1991–2004. Retrospectively, we analyzed patients regarding anastomosis‐related characteristics and clinical signs including sepsis, fever ≥39.0°C, leukocytosis ≥20 × 10^9^/ml and pleural effusion.
Results
Anastomotic leakage had appeared in 35 of the 211 patients. The clinical signs sepsis (odds ratio (OR) 6.72: 95% confidence interval (CI) (2.57–17.56); P < 0.0001), leukocytosis (OR 2.62 (1.10–6.22); P < 0.030), and fever (OR 2.34 (1.01–5.42); P < 0.047) were significantly related to anastomotic leakage. Pleural effusion was not significantly related to anastomotic leakage (OR 2.83 (0.98–8.13); P = 0.054).
Conclusion
Our study suggests that the clinical value for a routinely performed contrast examination is debatable. We recommend performing a contrast examination based on clinical suspicion and clinical signs of anastomotic leakage including sepsis, fever ≥39.0°C and leukocytosis ≥20 × 10^9^/ml. J. Surg. Oncol. 2009;100:699–702. © 2009 Wiley‐Liss, Inc.