OA05.4. Consensus-Based Treatment of Anastomotic Leakage After Esophagectomy

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Recently, an international consensus guideline for management of anastomotic leakage (AL) after esophagectomy was published in collaboration with the ISDE1. An expert panel formulated 23 evidence-based recommendations for clinical care. This study aimed to investigate the extent to which these guidelines are reflected in clinical practice. For this study, data of the TENTACLE - Esophagus was used. The TENTACLE - Esophagus is an international, retrospective cohort study including patients with AL after esophagectomy between 2010 and 2019. For each guideline recommendation, the number and corresponding percentage of patients whose management was consistent with the recommendation was reported. The primary outcome was adherence to guideline recommendations, defined as the proportion of patients whose medical management was consistent with the recommendations in the guideline. Secondary outcomes were differences in failure to rescue and differences in length of hospital stay compared between patients with management adherent to guideline recommendations and those managed with other strategies. Of 1509 patients with AL, 425 patients (28.2%) had local manifestations, 548 patients (36.3%) had intrathoracic manifestations, 145 patients (9.6%) had gastric conduit ischemia, and 390 patients (25.9%) with missing data regarding clinical manifestations. AL was confirmed by computed tomography (CT) in 743 patients (49.2%), by endoscopy in 182 patients (12.1%), and by other modalities in 584 patients (38.7%). Preliminary results show that of the 1118 included patients with AL, 48.9% (208 patients) with local manifestations and 67.3% (369 patients) with intrathoracic manifestations were treated according to the clinical care algorithm. Further analysis is currently being performed and will be ready for presentation at ISDE Kyoto. These results will include analysis on the outcomes of patients being treated in line with guideline recommendations versus patients in which guideline recommendations were not adhered to. This study evaluates whether current practice aligns with a very recently published consensus ISDE guideline on management of AL. Preliminary results indicate the majority of patients received treatment according to the clinical care algorithm. Further analysis is currently being performed and final results will be presentable at the ISDE Kyoto meeting.