Routine or on Demand Radiological Contrast Examination in the Diagnosis of Anastomotic Leakage After Esophagectomy

Background: To detect anastomotic leakage after esophagectomy in esophageal carcinoma patients, many surgeons perform a radiological contrast examination routinely. The aim of this retrospective study is to determine the clinical relevance of a routine contrast examination after esophagectomy and to evaluate criteria for contrast examination on demand. Methods: Data were obtained from 211 patients with cancer of the esophagus or gastro-esophageal junction who underwent an esophagectomy during the period 1991-2004. Retrospectively, we analyzed patients regarding anastomosis-related characteristics and clinical signs including sepsis, fever >= 39.0 degrees C, leukocytosis >= 20 x 10(9)/ml and pleural effusion. Results: Anastomotic leakage had appeared in 35 of the 211 patients. The clinical signs sepsis (odds ratio (OR) 6.72: 95% confidence interval (CI) (2.57-17.56); P < 0.0001), leukocytosis (OR 2.62 (1.10-6.22); P < 0.030), and fever (OR 2.34 (1.01-5.42); P < 0.047) were significantly related to anastomotic leakage. Pleural effusion was not significantly related to anastomotic leakage (OR 2.83 (0.98-8.13); P = 0.054). Conclusion: Our Study suggests that the clinical value for a routinely performed contrast examination is debatable. We recommend performing a contrast examination based on clinical suspicion and clinical signs of anastomotic leakage including sepsis. fever >= 39.0 degrees C and leukocytosis >= 20 x 10(9)/ml. J. Surg. Oncol. 2009:100:699-702. (C) 2009 Wiley-Liss, Inc.