Mode of presentation and severity of cervical anastomotic leak after McKeown esophagectomy in the era of endoscopic therapies.

Abstract

Introduction: Cervical drainage has been used to facilitate the diagnosis of anastomotic dehiscence (AD) and its local control. The aim of this study has been to analyse the association between the initial mode of presentation of cervical AD after McKeown esophagectomy (ME) and its overall clinical severity.

Materials and methods: This retrospective study included patients with oesophageal neoplasia who underwent ME between 2010 and 2024, developed cervical AD, and had a cervical drain in place. The mode of diagnosis (clinical presentation vs drainage output), treatment, and severity of AD were analysed using the Comprehensive Complication Index (CCI). A temporal analysis comparing the periods before and after 2020 was performed following the introduction of new endoscopic therapies. Multivariable linear regression was used to identify factors associated with CCI.

Results: A total of 31 patients with cervical AL were included. Diagnosis was established through the cervical drain in 14 patients (45.2%) and through clinical manifestations in 17 (54.8%). No significant differences were observed in time to diagnosis between the groups (p = 0.49). Temporal analysis showed a reduction in surgical treatment of AD after 2020 (p = 0.039). In the multivariable analysis, the independent factors associated with CCI were the mode of diagnosis (p = 0.043) and diagnostic delay (p = 0.041).

Conclusion: Diagnosis through cervical drainage was not associated with earlier detection of AD. Severity was mainly related to diagnostic delay and the mode of clinical presentation. The introduction of endoscopic therapies has reduced the need for surgery.