Improved anastomotic leakage rates after the “flap and wrap” reconstruction in Ivor Lewis esophagectomy for cancer

Abstract

Anastomotic leakage after esophagectomy has serious consequences. In Ivor Lewis esophagectomy, a shorter and possibly better vascularized gastric conduit is created than in McKeown esophagectomy. Intrathoracic anastomoses can additionally be wrapped in omentum and concealed behind the pleura (“f lap and wrap” reconstruction). Aims of this observational study were to assess the anastomotic leakage incidence after transhiatal esophagectomy (THE), McKeown esophagectomy (McKeown), Ivor Lewis esophagectomy (IL) without “f lap and wrap” reconstruction, and IL with “f lap and wrap” reconstruction. Consecutive patients undergoing esophagectomy at a tertiary referral center between January 2013 and April 2019 were included. Primary outcome was the anastomotic leakage rate. Secondary outcomes were postoperative outcomes, mortality, and 3-year overall survival. A total of 463 patients were included. The anastomotic leakage incidence after THE (n = 37), McKeown (n = 97), IL without “f lap and wrap” reconstruction (n = 39), and IL with “f lap and wrap” reconstruction (n = 290) were 24.3, 32.0, 28.2, and 7.2% (P < 0.001). THE and IL with “f lap and wrap” reconstruction required fewer reoperations for anastomotic leakage (0 and 1.4%) than McKeown and IL without “f lap and wrap” reconstruction (6.2 and 17.9%, P < 0.001). Fewer anastomotic leakages are observed after Ivor Lewis esophagectomy with “f lap and wrap” reconstruction compared to transhiatal, McKeown and Ivor Lewis esophagectomy without “f lap and wrap” reconstruction. The “f lap and wrap” reconstruction seems a promising technique to further reduce anastomotic leakages and its severity in esophageal cancer patients who have an indication for Ivor Lewis esophagectomy.