Anastomotic leak after oesophagectomy and stent implantation: a systematic review
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REVIEW
Anastomotic leak after oesophagectomy and stent implantation: a systematic review A. N. Kanatas • A. Aldouri • J. D. Hayden
Received: 19 December 2009 / Accepted: 29 March 2010 / Published online: 21 April 2010 Ó Springer-Verlag 2010
Abstract Anastomotic leaks following oesophageal cancer resection have a high mortality. Stents have an established position in the palliation of dysphagia due to malignancy and in treating malignant perforation or fistula. They are increasingly used for benign conditions such as spontaneous oesophageal perforation with encouraging results. In this systematic review we examine the available evidence and attempt to define the role of stents in the management of oesophageal anastomotic leaks after resection for cancer. It is evident from the review that plastic- and metal-covered stents are an effective strategy for the treatment of anastomotic leaks. Vigilance is required as complications such as stent migration and incomplete sealing are not uncommon. Further clinical studies with greater methodological rigor in terms of sample size and study design may confirm that stents have an important contribution to make in the management of oesophageal anastomotic leak. Keywords Oesophagectomy Stent implantation Management of anastomotic leaks
Introduction Anastomotic leaks following oesophageal cancer resection have an incidence of up to 17% and a mortality of up to 60% [1, 2]. There is no standardised approach for treating patients with symptomatic leaks. Management can include surgical intervention [3–6] percutaneous drainage [4, 6], antibacterial and antifungal treatment and nutritional support [7]. Stents have an established position in the palliation of dysphagia due to malignancy and in treating malignant perforation or fistula [3, 4]. They are increasingly used for benign conditions such as spontaneous oesophageal perforation with encouraging results [3]. Endoluminal stents are increasingly being deployed to treat oesophageal leaks following cancer resection [6]. Although this is an attractive therapeutic option, it is not without its hazards. Our aim was to evaluate the safety and efficacy of this strategy and define its role in the management of patients who have undergone oesophageal resection for cancer.
Materials and methods
A. N. Kanatas A. Aldouri J. D. Hayden (&) Department of Upper GI and Minimally Invasive Surgery, St James’s Hospital, St James’s Institute of Oncology, Level 3 Bexley Wing, Beckett Street, Leeds LS9 7TF, UK e-mail: [email protected] A. N. Kanatas Department of Oral and Maxillofacial Surgery, Leeds Dental Institute, The Worsley Building, Clarendon Way, Leeds LS2 9LU, UK
A literature search of the current Ovid MEDLINE database (up to the end of 2009) and allied versions (Cumulative Index to Nursing and Allied Health Literature; Evidence Based Medicine of Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; International Pharmaceutical Abstracts) was per
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