Anja Schaible1, Thorsten Brenner2, Ulf Hinz3, Thomas Schmidt3, Markus Weigand2, Peter Sauer4, Markus W Büchler3, Alexis Ulrich3. 1. Department of General Surgery, Heidelberg University Hospital, INF 110, 69120, Heidelberg, Germany. Anja.Schaible@med.uni-heidelberg.de. 2. Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany. 3. Department of General Surgery, Heidelberg University Hospital, INF 110, 69120, Heidelberg, Germany. 4. Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany.
Abstract
PURPOSE: Anastomotic leakage is the most frequent cause of postoperative mortality following esophageal surgery. However, no gold standard for diagnosing and managing leakage has been established. Continuous clinical judgment is extremely important; therefore, to optimize the management of leakage, we established a special group for decision-making in cases of suspected leakage in the early postoperative period. METHODS: Between January 2010 and December 2016, 234 consecutive patients underwent elective esophageal resection with a thoracoabdominal incision. In 2014, we established a group consisting of a surgeon, surgical endoscopist, and anesthesiologist for decision-making in cases of suspected leakage. They discussed emerging problems and decided on further diagnostics or therapy. The data were documented prospectively and compared to the years prior to 2014. RESULTS: Two hundred and thirty-four consecutive patients were enrolled in the study, 110 in the years 2010-2013 (group A), and 124 in the years 2014-2016 (group B). Neither patients' characteristics nor the rate of anastomotic leakage differed significantly between the two study groups. The hospital mortality rate was 10% (11 patients) in group A and 4.8% (six patients) in group B. Most interestingly, mortality due to anastomotic leakage was 35% in group A (9/26), whereas it decreased significantly to 6.5% (2/31 patients) (P < 0.001) in group B. CONCLUSIONS: Our data clearly demonstrated that optimizing the management of anastomotic leakage by making team decisions can lead to a significant decrease in mortality.
PURPOSE: Anastomotic leakage is the most frequent cause of postoperative mortality following esophageal surgery. However, no gold standard for diagnosing and managing leakage has been established. Continuous clinical judgment is extremely important; therefore, to optimize the management of leakage, we established a special group for decision-making in cases of suspected leakage in the early postoperative period. METHODS: Between January 2010 and December 2016, 234 consecutive patients underwent elective esophageal resection with a thoracoabdominal incision. In 2014, we established a group consisting of a surgeon, surgical endoscopist, and anesthesiologist for decision-making in cases of suspected leakage. They discussed emerging problems and decided on further diagnostics or therapy. The data were documented prospectively and compared to the years prior to 2014. RESULTS: Two hundred and thirty-four consecutive patients were enrolled in the study, 110 in the years 2010-2013 (group A), and 124 in the years 2014-2016 (group B). Neither patients' characteristics nor the rate of anastomotic leakage differed significantly between the two study groups. The hospital mortality rate was 10% (11 patients) in group A and 4.8% (six patients) in group B. Most interestingly, mortality due to anastomotic leakage was 35% in group A (9/26), whereas it decreased significantly to 6.5% (2/31 patients) (P < 0.001) in group B. CONCLUSIONS: Our data clearly demonstrated that optimizing the management of anastomotic leakage by making team decisions can lead to a significant decrease in mortality.
Authors: Geoffrey Paul Kohn; Joseph Anton Galanko; Michael Owen Meyers; Richard Harry Feins; Timothy Michael Farrell Journal: J Gastrointest Surg Date: 2009-09-16 Impact factor: 3.452
Authors: M S Maish; S R DeMeester; E Choustoulakis; J W Briel; J A Hagen; J H Peters; J C Lipham; C G Bremner; T R DeMeester Journal: Surg Endosc Date: 2005-07-28 Impact factor: 4.584
Authors: Arzu Oezcelik; Farzaneh Banki; Shahin Ayazi; Emmanuele Abate; Joerg Zehetner; Helen J Sohn; Jeffrey A Hagen; Steven R DeMeester; John C Lipham; Suzanne L Palmer; Tom R DeMeester Journal: Surg Endosc Date: 2010-02-05 Impact factor: 4.584
Authors: John W Briel; Anand P Tamhankar; Jeffrey A Hagen; Steven R DeMeester; Jan Johansson; Emmanouel Choustoulakis; Jeffrey H Peters; Cedric G Bremner; Tom R DeMeester Journal: J Am Coll Surg Date: 2004-04 Impact factor: 6.113
Authors: Natalie S Blencowe; Sean Strong; Angus G K McNair; Sara T Brookes; Tom Crosby; S Michael Griffin; Jane M Blazeby Journal: Ann Surg Date: 2012-04 Impact factor: 12.969
Authors: Marcel Hochreiter; Thomas Schmidt; Benedikt H Siegler; Leila Sisic; Karsten Schmidt; Thomas Bruckner; Beat P Müller-Stich; Markus K Diener; Markus A Weigand; Markus W Büchler; Cornelius J Busch Journal: World J Surg Date: 2020-07 Impact factor: 3.352
Authors: Chengcheng Christine Zhang; Lukas Liesenfeld; Rosa Klotz; Ronald Koschny; Christian Rupp; Thomas Schmidt; Markus K Diener; Beat P Müller-Stich; Thilo Hackert; Peter Sauer; Markus W Büchler; Anja Schaible Journal: BMC Gastroenterol Date: 2021-02-16 Impact factor: 3.067
Authors: Lukas F Liesenfeld; Peter Sauer; Markus K Diener; Ulf Hinz; Thomas Schmidt; Beat P Müller-Stich; Thilo Hackert; Markus W Büchler; Anja Schaible Journal: BMC Surg Date: 2020-12-09 Impact factor: 2.102