This document discusses 7 cases of anastomotic leakage after esophagectomy for cancer treatment at a hospital in Leeds, England between 2002-2005. It finds that 1/3 of leakages occurred early post-operatively (<5 days), while 2/3 occurred later (>5 days). 1/3 of early leakages were from the gastric tube and carried a high mortality risk, while 2/3 of later leakages were from the circular anastomosis and had a lower mortality risk. The document concludes leakages are generally acceptable below 10% incidence, but a mortality rate above 5% is unacceptable and signifies the need for a focused management strategy to address complications.

1. 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

2. Intra-Thoracic Oesophago-Gastric Anastomosis Routine POD #7 Gastrograffin Swallows – No Leakage 1 2 3

4. Early Post-operative Leakage: Limited Necrosis of Gastric Tube Repair of gastric tube around a 16Fr T-tube

8. Delayed Post-operative Leakage: Contained Sepsis, No Necrosis Leakage from anastomosis Mediastinal sinus, no cavity Anastomotic dehiscence No necrosis Non-Interventional Treatment

10. 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

15. Clinically suspected delayed post-operative leakage; Normal radiology Normal repeated contrast swallows Normal repeated cross-sectional imaging Normal Upper GI Endoscopy

16. Cervical Oesophago-Gastric Anastomosis Neck Upper chest Lower chest Abdomen Routine POD #7 Gastrograffin Swallows – No Leakage

18. Delayed Post-operative Cervical Anastomotic Leakage POD#12 Neck Sinus POD #17 Retro-sternal sinus POD#25 Pre-vertebral cavity

23. Intra-Thoracic Anastomosis 103 patients