P1.154. Delayed Unexplained Hemorrhage After Esophagectomy: Insights From a Nationwide Multicenter Questionnaire-Based Study

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Delayed unexplained postoperative hemorrhage after esophagectomy is a rare complication. Due to its low incidence, existing reports are limited, and high-quality evidence regarding its clinical characteristics, risk factors, and management strategies remains scarce. Consequently, standardized diagnostic and management protocols have not been established in current national or clinical guidelines. This study was conducted across eight high-volume esophageal cancer centers in China, and sixteen experienced esophageal surgeons were invited to complete a structured questionnaire. The collected data included patient demographics, perioperative surgical details, postoperative complications, hemorrhage characteristics, therapeutic interventions, and clinical outcomes. This questionnaire collected a total of 30 responses, with 24 patients ultimately included in the analysis. This data indicated that postoperative delayed unexplained hemorrhage predominantly occurred between days 5 and 7 after surgery. 18 patients experienced active bleeding and underwent secondary surgery for emergency re-exploration. A definitive bleeding source was identified intraoperatively in 16 cases (88.9%), primarily involving omental bleeding (43.8%). 1 patient died during the re-exploratory surgery due to massive hemorrhage. 2 patients died after re-exploratory procedures without a definitive cause of bleeding identified, occurring on the day of surgery and on the seventh postoperative day, respectively. Notably, 5 patients with concomitant anastomotic leakage also developed delayed hemorrhage, although the bleeding source was clearly unrelated to the anastomotic site. 3 patients survived after receiving intensive supportive treatment. Delayed unexplained massive hemorrhage after esophagectomy typically occurs between postoperative days 5 and 7 and is associated with diverse bleeding sources, most commonly the Greater omentum. Although bleeding can be surgically controlled in most cases, this condition remains a high mortality rate.