Persisting symptoms after intrathoracic anastomotic leak following oesophagectomy for cancer

Background: Intrathoracic anastomotic leak is a major cause of postoperative mortality and morbidity after resection for oesophageal cancer. Little is known about persisting symptoms after this complication. In this Swedish nationwide cohort study, it was hypothesized that intrathoracic anastomotic leak makes patients more susceptible to persisting eating difficulties, odynophagia, dysphagia, trouble swallowing saliva and reflux.

Methods: Patients who underwent oesophagectomy for oesophageal cancer, and had reconstruction with a gastric conduit and an intrathoracic anastomosis, between April 2001 and December 2005 were included. Symptoms were measured using an oesophageal cancer-specific health-related quality-of-life questionnaire (QLQ-OES18), developed by the European Organization for Research and Treatment of Cancer. Multivariable logistic regression models were used to calculate risk estimates for symptoms, expressed as odds ratio (OR) with 95 per cent confidence interval, 6 months after intrathoracic anastomotic leakage.

Results: Among the 277 patients included in the study, the 29 patients with an intrathoracic anastomotic leak had a fourfold increased risk (OR 4·05, 1·47 to 11·16) of eating difficulties and a more than twofold greater risk (OR 2·59, 1·15 to 5·82) of odynophagia, 6 months after surgery, compared with patients without a leak. There was a twofold increased risk of trouble swallowing, but this was not statistically significant (OR 1·98, 0·58 to 6·67).

Conclusion: Patients with an intrathoracic anastomotic leak after oesophageal cancer surgery were at increased risk of eating difficulties and odynophagia 6 months after surgery. Higher risks of reflux and dysphagia were not found among patients with anastomotic leak.