Treatment of intrathoracic anastomotic leakage following esophagectomy for gastroesophageal cancer: a systematic review

Anastomotic leakage (AL) is a significant complication following esophagectomy. AL affects 8%-17% of patients and is associated with increased morbidity, mortality, and hospital stay. To this date, no consensus exists on the most optimal treatment. This systematic review aimed to determine the most effective treatment approach. A systematic search of Medline, Web of Science, Cochrane, Scopus, and Embase databases was conducted. Only studies reporting on the treatment of intrathoracic anastomotic leakage after esophagectomy with gastric conduit reconstruction for cancer were included. Studies investigating other esophageal disorders or failing to report the location of the anastomosis were excluded. The methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale for cohort studies. Out of 12,966 identified studies, 38 were included for analysis after removing duplicates and screening titles, abstracts, and full texts. Of these, five were found to be of poor methodological quality and 33 were of moderate quality. The most researched treatment methods were Endoluminal vacuum therapy (EVT), naso-fistula tube drainage (NFTD), and stent treatment. The success and mortality rates for EVT were 82% and 10.7%, for NFTD, 94% and 5.2%, and, for stent treatment, 75.1% and 13.5%, respectively. AL can be effectively treated with EVT, stent treatment, and NFTD. The NFTD approach appeared to have a higher success rate and lower mortality than other treatment modalities. However, it requires a longer treatment duration. Due to limitations within the included studies, a definitive recommendation regarding the optimal treatment for AL cannot be made.