221. anastomotic leak after a cardio-oesophagectomy: a retrospective 12 year experience of a tertiary centre

Abstract Anastomotic leak (AL) post cardio-oesophagectomy remains a significant complication which can impact morbidity and mortality. Incidences of anastomotic leakage after oesophagectomy range between 0 and 20%. Current clinical practice is driven by regional centres and anecdotal experience. We present our 12 year experience with managing patients with anastomotic leaks. This was a retrospective study using the electronic database to analyse the incidence of anastomotic leak in consecutive patients who underwent elective cardio-oesophagectomy from April 2009 to December 2021 in a Tertiary Upper GI cancer centre. The grade of the AL was determined according to the Clavien-Dindo Grade (CDG). A leak associated with Grade > III was categorised as severe anastomotic leak. We used Cox multivariable analysis to observe any link in the severity of the anastomotic leak and prognosis. A total of 560 patients underwent cardio-oesophagectomy. The median length of stay was 13 (Range 3 to 148 days) days and the median age was 66 (46–79) years. M/F 2:1. AL was seen in 26 cases (4.3%); of which 9 cases (0.7%) were classified as severe AL (CDG > 3). Our results are presented on the table attached. Statistical analysis does not show any link between the severity of the anastomotic leak, those who had neoadjuvant therapy and the survival outcome. Anastomotic leaks of all grades prolongs both ITU and hospital stay. This subsequently causes delays in adjuvant therapies affecting long term prognosis. Aggressive treatment early on for large leaks suggests no significant compromise on over-all long-term prognosis.