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Anastomotic Leakage after Oesophagectomy for Cancer: A Mortality-Free Experience Abeezar I Sarela, Damian J Tolan, Keith Harris,  Simon P Dexter, Henry M Sue-Ling Departments of Upper GI Surgery & Radiology The General Infirmary at Leeds J Am Coll Surg 2008;206:516–523
Intra-Thoracic Oesophago-Gastric Anastomosis Routine POD #7 Gastrograffin Swallows – No Leakage 1 2 3
Intra-Thoracic Leakage Case # 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Early Post-operative Leakage:  Limited Necrosis of Gastric Tube Repair of gastric tube around a 16Fr T-tube
Intra-Thoracic Leakage Case # 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Early Post-operative Leakage: Extensive Necrosis of Gastric Tube
Intra-Thoracic Leakage Case #3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Leakage: Contained Sepsis, No Necrosis  Leakage from anastomosis Mediastinal sinus, no cavity Anastomotic dehiscence No necrosis Non-Interventional Treatment
Intra-Thoracic Leakage Case#4 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Intra-Thoracic Leakage: Apical Sinus + Pleural Cavity Leakage from apex of gastric tube Cavity with air-fluid level Percutaneous drainage by interventional radiology
Intra-Thoracic Leakage Case # 5 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Leakage: Generalised Pleural Contamination  POD#8 POD#9 6.30AM POD#9 9.00PM ,[object Object],[object Object]
Intra-Thoracic Leakage Case # 6 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Suspected leakage at O-G anastomosis
Intra-Thoracic Leakage Case # 7 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinically suspected delayed post-operative leakage; Normal radiology Normal repeated contrast swallows Normal repeated cross-sectional imaging Normal Upper GI Endoscopy
Cervical Oesophago-Gastric Anastomosis Neck Upper chest Lower chest Abdomen Routine POD #7 Gastrograffin Swallows – No Leakage
Cervical Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Cervical Anastomotic Leakage POD#12 Neck Sinus  POD #17 Retro-sternal sinus POD#25 Pre-vertebral cavity
Implications  of Anastomotic Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer The General Infirmary at Leeds ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Identification of Leakage ,[object Object],[object Object],[object Object],[object Object]
Site of Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object]
Intra-Thoracic Anastomosis 103 patients
Intra-Thoracic Anastomotic Leakage ,[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer Memorial Sloan Kettering Cancer Center   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer Queen Mary Hospital, Hong Kong ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer Royal Victoria Hospital, Newcastle ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer  University of Michigan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Personal Lessons ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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