Abstract Background Anastomotic leakage (AL) remains one of the most feared complications after esophagectomy. Preemptive endoscopic vacuum therapy (pEVT) has been proposed to support anastomotic healing, but robust clinical data remain limited. This study aimed to evaluate the role of pEVT in the management of AL. Methods A retrospective cohort study analyzed 116 esophageal cancer patients who experienced AL after Ivor Lewis esophagectomy between 2012 and 2023. The patients were categorized into two groups: those who received therapeutic EVT (tEVT) after AL diagnosis without prior pEVT and those who experienced AL despite receiving pEVT and subsequently required tEVT as well. Clinical outcomes, leak severity, and hospital metrics were compared with a focus on endoscopic management of AL. Results The patients in the pEVT group presented with significantly less severe leaks (ZACC grade II: 36.7% vs. 5.4%; p < 0.001), required less intracavitary therapy (43.4% vs. 67.9%; p = 0.027), and exhibited lower postoperative inflammation. Preemptive EVT was independently associated with favorable leak grading (odds ratio, 14.4; p = 0.004), a 69% reduced need for intracavitary treatment ( p = 0.027), and markedly shorter intensive care unit (ICU: −74.4%; p < 0.001) and hospital (−27.5%; p = 0.011) stays. The overall healing rate was high in both groups (pEVT: 85%; non-pEVT: 80.4%). Conclusions Preemptive EVT significantly reduces the clinical severity of AL and facilitates faster recovery by shortening ICU and hospital stays. These findings highlight its value as a preventive strategy for high-risk patients undergoing esophagectomy. Prospective studies are needed to validate these promising results.
Merten et al. (2026) studied this question.