Multicenter study on the incidence and treatment of mediastinal leaks after esophagectomy (mumele 2)

Background Management of mediastinal anastomotic leaks (MALs) after Ivor Lewis esophagectomy includes conservative, endoscopic, or surgical management. Endoscopic vacuum therapy (EVAC) is becoming a routine approach for MALs, although the outcomes have not been defined. Purpose This study describes the incidence, treatment, and outcomes of MALs in patients who underwent esophagectomy in three Italian high-volume centers that routinely use EVAC for MAL. Methods Patients who underwent Ivor Lewis esophagectomy between September 2018 and March 2023 were included. Results A total of 681 patients underwent Ivor Lewis esophagectomy, of whom 88 had an MAL. MAL rates for open, minimally invasive, and robotic esophagectomy were 11.5%, 13.4%, and 14.8%, respectively. Global and specific 30- and 90-day mortality rates for MAL were 0.9% and 2.1% and 6.8% and 15.9%, respectively. Nonoperative management (NOM) as primary treatment was chosen for 62 patients. The most common NOM and OM was EVAC (62.9%) and anastomotic redo (53.8%), respectively. Diversion was the OM for seven patients, three of whom died. Primary treatment proved successful in 40 patients. Among them, EVAC alone was successful in 35.9% of patients. Globally, endoscopic treatment including EVAC was successful in 79% of NOM and 55.7% of MALs. NOM and OM were chosen as secondary treatment for 27 and 10 patients, respectively. Secondary treatment proved successful in 21 patients. Conclusions The incidence of MAL after Ivor Lewis esophagectomy is approximately 13%. Endoscopic techniques have a success rate of almost 80%, with EVAC representing a significant part of this treatment process.