In:
Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 274, No. 5 ( 2021-11), p. 751-757
Kurzfassung:
Preemptive endoluminal vacuum therapy (pEVT) is a novel concept to reduce postoperative morbidity and has the potential to disrupt current treatment paradigms for patients undergoing esophagectomy. Summary of Background Data: Endoluminal vacuum therapy is an accepted treatment for AL after esophagectomy. Methods: Retrospective analysis of patients undergoing minimally invasive Ivor Lewis esophagectomy with pEVT between 11/2017 and 10/2020. The sponge was removed endoscopically after 4–6 days, and anastomosis and gastric conduit were assessed according to a novel endoscopic grading system. Further management was customized according to endoscopic appearance and clinical course. Endpoints were postoperative morbidity and AL rate, defined according to the Clavien-Dindo (CD) and International Esodata Study Group classifications. Results: PEVT was performed in 67 consecutive patients, 57 (85%) were high-risk patients with an ASA score 〉 2, WHO/ECOG score 〉 1, age 〉 65 years, or BMI 〉 29 kg/m 2 . Thirty patients experienced textbook outcome, and overall minor (≤CD IIIa) and major (≥CD IIIb) morbidity was 40.3% and 14.9% respectively. 30-day-mortality was 0%. Forty-nine patients (73%) had uneventful anastomotic healing after pEVT without further endoscopic treatment. The remaining 18 patients (27%) underwent prolonged EVT with uneventful anastomotic healing in 13 patients (19%), contained AL in 4 patients (6%), and 1 uncontained leakage (1.5%) in a case with proximal gastric conduit necrosis, resulting in an overall AL rate of 7.5%. Conclusions: PEVT is an innovative and safe procedure with a promising potential to reduce postoperative morbidity after minimally invasive Ivor Lewis esophagectomy and may be particularly valuable in highly comorbid cases.
Materialart:
Online-Ressource
ISSN:
0003-4932
,
1528-1140
DOI:
10.1097/SLA.0000000000005125
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2021
ZDB Id:
2641023-0
ZDB Id:
2002200-1
