Classification and Healing Time Analysis of Esophageal Anastomotic Leaks After Esophagectomy

Background Anastomotic leakage (AL) is a severe complication after esophagectomy, but the classifications of anastomotic leakage and their respective healing times are poorly studied. Methods This study retrospectively analyzed 117 cases of AL among 2871 patients who underwent esophagectomy with circular stapled anastomosis of the esophagus and gastric tube at our hospital from January 1, 2019, to March 31, 2024. AL cases were categorized into four types based on the direction of leakage (anterior, right, posterior, and left). The differences in healing times among these four types were analyzed using the log-rank test. Results The incidence of AL was 4.3% (117/2728), with a median occurrence time of 9 days (IQR 5) and a median healing time of 56 days (IQR 64). Single cervical ALs accounted for only 17.5%, and their healing times were significantly shorter compared to intrathoracic leaks (33 days vs. 61 days, p = 0.018). Right-sided leaks were the most common (49.6%), while left-sided leaks healed faster than right- and posterior-sided leaks (42 days vs. 63 days vs. 70 days, p < 0.05). The occurrence of tracheoesophageal fistulas and pneumothorax led to prolonged healing times. BMI, diabetes, and neoadjuvant therapy did not influence healing time. Conclusion These findings provide valuable insights for clinicians to better understand the mechanisms of AL development and predict their healing times.