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.