Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study
Sander Ubels
,
Moniek Verstegen
,
Bastiaan Klarenbeek
,
Stefan Bouwense
,
Mark van Berge Henegouwen
,
Freek Daams
,
Marc van Det
,
Ewen Griffiths
,
Jan Willem Haveman
,
Joos Heisterkamp
,
Grard Nieuwenhuijzen
,
Fatih Polat
,
Jeroen Schouten
(1)
,
Peter Siersema
,
Pritam Singh
(2)
,
Bas Wijnhoven
,
Gerjon Hannink
(3)
,
Frans van Workum
,
Camiel Rosman
,
Eric Matthée
,
Cettela Slootmans
,
Gijs Ultee
,
Suzanne Gisbertz
,
Wietse Eshuis
,
Marianne Kalff
,
Minke Feenstra
,
Donald van der Peet
,
Wessel Stam
,
Boudewijn van Etten
,
Floris Poelmann
,
Nienke Vuurberg
,
Jan Willem van den Berg
,
Ingrid Martijnse
,
Robert Matthijsen
,
Misha Luyer
,
Wout Curvers
,
Tom Nieuwenhuijzen
,
Annick Taselaar
,
Ewout Kouwenhoven
,
Merel Lubbers
,
Meindert Sosef
,
Frederik Lecot
,
Tessa Geraedts
,
Stijn van Esser
,
Jan Willem T Dekker
,
Frits van den Wildenberg
,
Wendy Kelder
,
Merel Lubbers
,
Peter Baas
,
Job de Haas
,
Henk Hartgrink
,
Renu Bahadoer
,
Johanna van Sandick
,
Koen Hartemink
,
Xander Veenhof
,
Hein Stockmann
,
Burak Gorgec
,
Pepijn Weeder
,
Marinus Wiezer
,
Charlotte Genders
,
Eric Belt
,
Bjorn Blomberg
,
Peter van Duijvendijk
,
Linda Claassen
,
David Reetz
,
Pascal Steenvoorde
,
Walter Mastboom
,
Henk Jan Klein Ganseij
,
Annette van Dalsen
,
Annalie Joldersma
,
Marije Zwakman
,
Richard Groenendijk
,
Mahsa Montazeri
,
Stuart Mercer
,
Benjamin Knight
,
Gijs van Boxel
,
Richard Mcgregor
,
Richard Skipworth
,
Cristina Frattini
,
Alice Bradley
,
Magnus Nilsson
,
Masaru Hayami
,
Biying Huang
,
James Bundred
,
Richard Evans
,
Peter Grimminger
,
Pieter van der Sluis
,
Uzun Eren
,
John Saunders
,
Elena Theophilidou
,
Zubair Khanzada
,
Jessie Elliott
,
Jeroen Ponten
,
Sinead King
,
John Reynolds
,
Bruno Sgromo
,
Khalid Akbari
,
Samar Shalaby
,
Christian Gutschow
,
Henner Schmidt
,
Diana Vetter
,
Krishna Moorthy
,
Mohamed Ibrahim
,
Grigorious Christodoulidis
,
Jari Räsänen
,
Juha Kauppi
,
Henna Söderström
,
Renol Koshy
,
Dimitrios Manatakis
,
Dimitrios Korkolis
,
Dimitrios Balalis
,
Aliki Rompu
,
Bilal Alkhaffaf
,
Mohamed Alasmar
,
Moaad Arebi
,
Guillaume Piessen
(4, 5)
,
Frederiek Nuytens
,
Sebastien Degisors
,
Ahmed Ahmed
,
Alex Boddy
,
Suraj Gandhi
,
Oluwatomini Fashina
,
Elke van Daele
,
Piet Pattyn
,
William Robb
,
Mayilone Arumugasamy
,
Mohammed Al Azzawi
,
Jack Whooley
,
Elif Colak
,
Engin Aybar
,
Ahmet Sari
,
Mustafa Uyanik
,
Ahmet Ciftci
,
Raza Sayyed
,
Bushra Ayub
,
Ghulam Murtaza
,
Aniqa Saeed
,
Priyanka Ramesh
,
Alexandros Charalabopoulos
,
Theodore Liakakos
,
Dimitrios Schizas
,
Efstratia Baili
,
Alkistis Kapelouzou
,
Michele Valmasoni
,
Elisa Sefora Pierobon
,
Giovanni Capovilla
,
Stefano Merigliano
,
Silviu Constantinoiu
,
Rodica Birla
,
Florin Achim
,
Cristian Gelu Rosianu
,
Petre Hoara
,
Raúl Guevara Castro
,
Andrés Felipe Salcedo
,
Ionut Negoi
,
Valentina Negoita
,
Cezar Ciubotaru
,
Bogdan Stoica
,
Sorin Hostiuc
,
Nicola Colucci
,
Stefan Mönig
,
Charles-Henri Wassmer
,
Jeremy Meyer
,
Flavio Roberto Takeda
,
Rubens Antonio Aissar Sallum
,
Ulysses Ribeiro
,
Ivan Cecconello
,
Enrique Toledo
,
Maria Soledad Trugeda
,
María José Fernández
,
Carolina Gil
,
Sonia Castanedo
,
Arda Isik
,
Eray Kurnaz
,
José Flávio Videira
,
Mariana Peyroteo
,
Rita Canotilho
,
Jacopo Weindelmayer
,
Simone Giacopuzzi
,
Carlo Alberto de Pasqual
,
Marcos Bruna
,
Fernando Mingol
,
Javier Vaque
,
Carla Pérez
,
Alexander Phillips
,
Jakub Chmelo
,
Joshua Brown
,
Renol Koshy
,
Laura Han
,
James Gossage
,
Andrew Davies
,
Cara Baker
,
Mark Kelly
,
Mohamed Saad
,
Daniele Bernardi
,
Luigi Bonavina
,
Emanuele Asti
,
Carlo Riva
,
Rosa Scaramuzzo
,
Muhammed Elhadi
,
Hazem Abdelkarem Ahmed
,
Ahmed Elhadi
,
Faruk Ali Elnagar
,
Ahmed Msherghi
,
Vanessa Wills
,
Cassidy Campbell
,
Marisol Perez Cerdeira
,
Scott Whiting
,
Neil Merrett
,
Amitabha Das
,
Christos Apostolou
,
Aldenb Lorenzo
,
Fabiana Sousa
,
José Adelino Barbosa
,
Vítor Devezas
,
Elisabete Barbosa
,
Cristina Fernandes
,
Garett Smith
,
Edward Li
,
Nazim Bhimani
,
Priscilla Chan
,
Krishna Kotecha
,
Michael Hii
,
Salena Ward
,
Maryann Johnson
,
Matthew Read
,
Lynn Chong
,
Michael Hollands
,
Matthew Allaway
,
Arthur Richardson
,
Emma Johnston
,
Andy Chen
,
Harsh Kanhere
,
Shalvin Prasad
,
Patrick Mcquillan
,
Tim Surman
,
Markus Trochsler
,
W Schofield
,
Syeda Khadijah Ahmed
,
Jessica Reid
,
Mark Harris
,
Sivakumar Gananadha
,
Jessica Farrant
,
Nicole Rodrigues
,
James Fergusson
,
Andrew Hindmarsh
,
Zeeshan Afzal
,
Peter Safranek
,
Vijay Sujendran
,
Siobhan Rooney
,
Carlos Loureiro
,
Saioa Leturio Fernández
,
Ismael Díez del Val
,
Shameen Jaunoo
,
Lauren Kennedy
,
Ahmed Hussain
,
Dimitrios Theodorou
,
Tania Triantafyllou
,
Charalampos Theodoropoulos
,
Theodora Palyvou
,
Muhammed Elhadi
,
Fatima Abdullah Ben Taher
,
Mustafa Ekheel
,
Ahmed Msherghi
1
Radboud University Medical Center [Nijmegen]
2 Saint Mary's Hospital [London]
3 Orthopaedic Research Laboratory
4 CANTHER - Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
2 Saint Mary's Hospital [London]
3 Orthopaedic Research Laboratory
4 CANTHER - Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
Sander Ubels
- Function : Author
- PersonId : 1368040
- ORCID : 0000-0002-9649-5436
Moniek Verstegen
- Function : Author
- PersonId : 1368041
- ORCID : 0000-0002-8371-509X
Bastiaan Klarenbeek
- Function : Author
- PersonId : 1368042
- ORCID : 0000-0003-2178-8557
Stefan Bouwense
- Function : Author
- PersonId : 1368043
- ORCID : 0000-0002-7600-9429
Mark van Berge Henegouwen
- Function : Author
- PersonId : 1368044
- ORCID : 0000-0001-8689-3134
Freek Daams
- Function : Author
Marc van Det
- Function : Author
Ewen Griffiths
- Function : Author
- PersonId : 1368045
- ORCID : 0000-0001-6630-3547
Jan Willem Haveman
- Function : Author
Joos Heisterkamp
- Function : Author
Grard Nieuwenhuijzen
- Function : Author
- PersonId : 1368046
- ORCID : 0000-0002-5837-5513
Fatih Polat
- Function : Author
Peter Siersema
- Function : Author
Bas Wijnhoven
- Function : Author
- PersonId : 1368047
- ORCID : 0000-0003-4738-3697
Frans van Workum
- Function : Author
- PersonId : 1368048
- ORCID : 0000-0003-0623-9066
Camiel Rosman
- Function : Author
- PersonId : 1368049
- ORCID : 0000-0002-9152-3987
Eric Matthée
- Function : Author
Cettela Slootmans
- Function : Author
Gijs Ultee
- Function : Author
Suzanne Gisbertz
- Function : Author
Wietse Eshuis
- Function : Author
Marianne Kalff
- Function : Author
Minke Feenstra
- Function : Author
Donald van der Peet
- Function : Author
Wessel Stam
- Function : Author
Boudewijn van Etten
- Function : Author
Floris Poelmann
- Function : Author
Nienke Vuurberg
- Function : Author
Jan Willem van den Berg
- Function : Author
Ingrid Martijnse
- Function : Author
Robert Matthijsen
- Function : Author
Misha Luyer
- Function : Author
Wout Curvers
- Function : Author
Tom Nieuwenhuijzen
- Function : Author
Annick Taselaar
- Function : Author
Ewout Kouwenhoven
- Function : Author
Merel Lubbers
- Function : Author
Meindert Sosef
- Function : Author
Frederik Lecot
- Function : Author
Tessa Geraedts
- Function : Author
Stijn van Esser
- Function : Author
Jan Willem T Dekker
- Function : Author
Frits van den Wildenberg
- Function : Author
Wendy Kelder
- Function : Author
Merel Lubbers
- Function : Author
Peter Baas
- Function : Author
Job de Haas
- Function : Author
Henk Hartgrink
- Function : Author
Renu Bahadoer
- Function : Author
Johanna van Sandick
- Function : Author
Koen Hartemink
- Function : Author
Xander Veenhof
- Function : Author
Hein Stockmann
- Function : Author
Burak Gorgec
- Function : Author
Pepijn Weeder
- Function : Author
Marinus Wiezer
- Function : Author
Charlotte Genders
- Function : Author
Eric Belt
- Function : Author
Bjorn Blomberg
- Function : Author
Peter van Duijvendijk
- Function : Author
Linda Claassen
- Function : Author
David Reetz
- Function : Author
Pascal Steenvoorde
- Function : Author
Walter Mastboom
- Function : Author
Henk Jan Klein Ganseij
- Function : Author
Annette van Dalsen
- Function : Author
Annalie Joldersma
- Function : Author
Marije Zwakman
- Function : Author
Richard Groenendijk
- Function : Author
Mahsa Montazeri
- Function : Author
Stuart Mercer
- Function : Author
Benjamin Knight
- Function : Author
Gijs van Boxel
- Function : Author
Richard Mcgregor
- Function : Author
Richard Skipworth
- Function : Author
Cristina Frattini
- Function : Author
Alice Bradley
- Function : Author
Magnus Nilsson
- Function : Author
Masaru Hayami
- Function : Author
Biying Huang
- Function : Author
James Bundred
- Function : Author
Richard Evans
- Function : Author
Peter Grimminger
- Function : Author
Pieter van der Sluis
- Function : Author
Uzun Eren
- Function : Author
John Saunders
- Function : Author
Elena Theophilidou
- Function : Author
Zubair Khanzada
- Function : Author
Jessie Elliott
- Function : Author
Jeroen Ponten
- Function : Author
Sinead King
- Function : Author
John Reynolds
- Function : Author
Bruno Sgromo
- Function : Author
Khalid Akbari
- Function : Author
Samar Shalaby
- Function : Author
Christian Gutschow
- Function : Author
Henner Schmidt
- Function : Author
Diana Vetter
- Function : Author
Krishna Moorthy
- Function : Author
Mohamed Ibrahim
- Function : Author
Grigorious Christodoulidis
- Function : Author
Jari Räsänen
- Function : Author
Juha Kauppi
- Function : Author
Henna Söderström
- Function : Author
Renol Koshy
- Function : Author
Dimitrios Manatakis
- Function : Author
Dimitrios Korkolis
- Function : Author
Dimitrios Balalis
- Function : Author
Aliki Rompu
- Function : Author
Bilal Alkhaffaf
- Function : Author
Mohamed Alasmar
- Function : Author
Moaad Arebi
- Function : Author
Frederiek Nuytens
- Function : Author
Sebastien Degisors
- Function : Author
Ahmed Ahmed
- Function : Author
Alex Boddy
- Function : Author
Suraj Gandhi
- Function : Author
Oluwatomini Fashina
- Function : Author
Elke van Daele
- Function : Author
Piet Pattyn
- Function : Author
William Robb
- Function : Author
Mayilone Arumugasamy
- Function : Author
Mohammed Al Azzawi
- Function : Author
Jack Whooley
- Function : Author
Elif Colak
- Function : Author
Engin Aybar
- Function : Author
Ahmet Sari
- Function : Author
Mustafa Uyanik
- Function : Author
Ahmet Ciftci
- Function : Author
Raza Sayyed
- Function : Author
Bushra Ayub
- Function : Author
Ghulam Murtaza
- Function : Author
Aniqa Saeed
- Function : Author
Priyanka Ramesh
- Function : Author
Alexandros Charalabopoulos
- Function : Author
Theodore Liakakos
- Function : Author
Dimitrios Schizas
- Function : Author
Efstratia Baili
- Function : Author
Alkistis Kapelouzou
- Function : Author
Michele Valmasoni
- Function : Author
Elisa Sefora Pierobon
- Function : Author
Giovanni Capovilla
- Function : Author
Stefano Merigliano
- Function : Author
Silviu Constantinoiu
- Function : Author
Rodica Birla
- Function : Author
Florin Achim
- Function : Author
Cristian Gelu Rosianu
- Function : Author
Petre Hoara
- Function : Author
Raúl Guevara Castro
- Function : Author
Andrés Felipe Salcedo
- Function : Author
Ionut Negoi
- Function : Author
Valentina Negoita
- Function : Author
Cezar Ciubotaru
- Function : Author
Bogdan Stoica
- Function : Author
Sorin Hostiuc
- Function : Author
Nicola Colucci
- Function : Author
Stefan Mönig
- Function : Author
Charles-Henri Wassmer
- Function : Author
Jeremy Meyer
- Function : Author
Flavio Roberto Takeda
- Function : Author
Rubens Antonio Aissar Sallum
- Function : Author
Ulysses Ribeiro
- Function : Author
Ivan Cecconello
- Function : Author
Enrique Toledo
- Function : Author
Maria Soledad Trugeda
- Function : Author
María José Fernández
- Function : Author
Carolina Gil
- Function : Author
Sonia Castanedo
- Function : Author
Arda Isik
- Function : Author
Eray Kurnaz
- Function : Author
José Flávio Videira
- Function : Author
Mariana Peyroteo
- Function : Author
Rita Canotilho
- Function : Author
Jacopo Weindelmayer
- Function : Author
Simone Giacopuzzi
- Function : Author
Carlo Alberto de Pasqual
- Function : Author
Marcos Bruna
- Function : Author
Fernando Mingol
- Function : Author
Javier Vaque
- Function : Author
Carla Pérez
- Function : Author
Alexander Phillips
- Function : Author
Jakub Chmelo
- Function : Author
Joshua Brown
- Function : Author
Renol Koshy
- Function : Author
Laura Han
- Function : Author
James Gossage
- Function : Author
Andrew Davies
- Function : Author
Cara Baker
- Function : Author
Mark Kelly
- Function : Author
Mohamed Saad
- Function : Author
Daniele Bernardi
- Function : Author
Luigi Bonavina
- Function : Author
Emanuele Asti
- Function : Author
Carlo Riva
- Function : Author
Rosa Scaramuzzo
- Function : Author
Muhammed Elhadi
- Function : Author
Hazem Abdelkarem Ahmed
- Function : Author
Ahmed Elhadi
- Function : Author
Faruk Ali Elnagar
- Function : Author
Ahmed Msherghi
- Function : Author
Vanessa Wills
- Function : Author
Cassidy Campbell
- Function : Author
Marisol Perez Cerdeira
- Function : Author
Scott Whiting
- Function : Author
Neil Merrett
- Function : Author
Amitabha Das
- Function : Author
Christos Apostolou
- Function : Author
Aldenb Lorenzo
- Function : Author
Fabiana Sousa
- Function : Author
José Adelino Barbosa
- Function : Author
Vítor Devezas
- Function : Author
Elisabete Barbosa
- Function : Author
Cristina Fernandes
- Function : Author
Garett Smith
- Function : Author
Edward Li
- Function : Author
Nazim Bhimani
- Function : Author
Priscilla Chan
- Function : Author
Krishna Kotecha
- Function : Author
Michael Hii
- Function : Author
Salena Ward
- Function : Author
Maryann Johnson
- Function : Author
Matthew Read
- Function : Author
Lynn Chong
- Function : Author
Michael Hollands
- Function : Author
Matthew Allaway
- Function : Author
Arthur Richardson
- Function : Author
Emma Johnston
- Function : Author
Andy Chen
- Function : Author
Harsh Kanhere
- Function : Author
Shalvin Prasad
- Function : Author
Patrick Mcquillan
- Function : Author
Tim Surman
- Function : Author
Markus Trochsler
- Function : Author
W Schofield
- Function : Author
Syeda Khadijah Ahmed
- Function : Author
Jessica Reid
- Function : Author
Mark Harris
- Function : Author
Sivakumar Gananadha
- Function : Author
Jessica Farrant
- Function : Author
Nicole Rodrigues
- Function : Author
James Fergusson
- Function : Author
Andrew Hindmarsh
- Function : Author
Zeeshan Afzal
- Function : Author
Peter Safranek
- Function : Author
Vijay Sujendran
- Function : Author
Siobhan Rooney
- Function : Author
Carlos Loureiro
- Function : Author
Saioa Leturio Fernández
- Function : Author
Ismael Díez del Val
- Function : Author
Shameen Jaunoo
- Function : Author
Lauren Kennedy
- Function : Author
Ahmed Hussain
- Function : Author
Dimitrios Theodorou
- Function : Author
Tania Triantafyllou
- Function : Author
Charalampos Theodoropoulos
- Function : Author
Theodora Palyvou
- Function : Author
Muhammed Elhadi
- Function : Author
Fatima Abdullah Ben Taher
- Function : Author
Mustafa Ekheel
- Function : Author
Ahmed Msherghi
- Function : Author
Abstract
Abstract Background Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. Methods A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011–2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. Results Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. −1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. −1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. −21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. Conclusion Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.