Classification and evaluation of anastomotic leaks after esophageal surgery-a tertiary university experience

Background Anastomotic insufficiency of the esophagus is the most feared complication of surgeons, leading to high postoperative morbidity and mortality. However, there is no internationally accepted guideline for its classification and treatment algorithm. Therefore, the aim of this study was to analyze the detection of anastomotic leaks as well as to discuss and validate the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound in late 2018. Methods All patients undergoing surgery for malignancy of the esophagogastric junction between 2013 and 2020 were analyzed. Out of these patients, those diagnosed with an anastomotic insufficiency were extracted and classified according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Continuous variables were expressed as medians, categorical variables were compared using Fisher's exact test or chi-square test. Results From 2013 to 2020, all 23 patients (10.84%) who developed an anastomotic leak after esophageal surgery were included in this study. The study revealed a significant increase in median hospital stay, median intensive care unit stay, and overall mortality rate (p = 0.028) with increased classification type. Conclusion The results of this study showed that the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound can be validated and that there is a clear differentiation between the subtypes. Standardized diagnosis and management improve the overall outcome of patients. Main novel aspects This article gives an introduction to classifying anastomotic insufficiencies according to the classification proposed by the Surgical Working Group on Endoscopy and Ultrasound. Results of the classification can be validated, with a clear differentiation of postoperative outcome between subtypes.