Y. Shoji1, H. Takeuchi1, H. Kawakubo1, K. Fukuda1, R. Nakamura1, T. Takahashi1, N. Wada1, Y. Kitagawa1 1Keio University, School Of Medicine,Department Of Surgery,Tokyo, TOKYO, Japan
Introduction: Operation for esophageal cancer is one of the most invasive operation in digestive surgery. Incidence of postoperative complication is relatively high than that of other gastrointestinal tract surgery. Anastomotic leakage is one of the critical complications after esophagectomy. Early diagnosis and initiation of treatment is essential. In our institute, we developed a new diagnostic procedure for postoperative anastomotic leakage using computed tomography examination (CT) at the 6th postoperative day after esophagectomy for esophagial cancer.?
Methods: From January 2012 to April 2015, 156 patients with esophageal cancer underwent curative resection under thoracolaparotomy in our institute. We made a comparative review of patient characteristics, surgical outcomes, and findings from the postoperative CT and the videofluorographic examination for swallowing (VF) of the 138 patients, which were reconstructed primary by the gastric tube (including salvage operation). Anastomotic leakage was defined as discharge of the digestive fluid from wounds or drains, which required medical and/or operative treatment (above grade 2 in Clavien – Dindo classification). Gastric tube stump leakage and anastomotic leakage were undifferentiated.
Results: Twenty-four cases, 17% suffered Anastomotic leakage (AL (+) group), and 114 cases, 83% did not (AL (-) group). There were no significant differences in patient characteristics such as age, sex, stage of the disease, location of the tumor, and preoperative treatment such as endoscopic extraction and chemotherapy and/or radiation therapy. Surgical outcomes such as usage of laparoscope / thoracoscope, field of lymph node dissection, reconstruction route, anastomotic site, operative duration, and intraoperative blood loss were equivalent in both groups. Mean number of air-bubbles (larger than 2 mm in diameter) in the cervical division and the mediastinal space by the CT image was significantly higher in the AL (+) group (AL (+) group, 4.8; AL (-) group, 0.7; P<0.001). When we decide 3 air-bubbles as a cutoff value ("air – bubble sign"), sensitivity and specificity of "air – bubble sign" against anastomotic leakage were 92% and 96%, respectively. In contrast, sensitivity and specificity of the postoperative VF against anastomotic leakage were 63% and 100%, respectively.
Conclusion: "Air-bubble sign" in the postoperative CT has higher sensitivity?than VF for diagnosis of anastomotic leakage after esophagectomy. "Air – bubble sign" may be a substitute for VF.