P1.202. Management and Outcomes of Anastomotic Leak After Oesophagectomy in Patients With Oesophageal Cancer

Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Anastomotic leak (AL) after oesophagectomy is a dreaded complication with significant implications on patient outcomes. Early detection of leak, advances in perioperative care and management techniques may improve long-term outcomes. This study was performed to assess the management patterns of anastomotic leak and its short-term and long-term consequences. Methods A retrospective study was conducted of 324 patients who underwent oesophagectomy between January 2015 and December 2024 at a tertiary cancer hospital. Patients who developed anastomotic leak were included for the analysis. Demographic and clinical data were retrieved from prospectively maintained electronic medical records. Surgical outcomes, management patterns and survival data were analyzed using SPSS. Results Fifty-one patients (16%) developed AL during this period. Majority (80%) had SCC and 94% received neoadjuvant therapy. Forty-two patients (82%) underwent transthoracic oesophagectomy and nine (18%) had Ivor-Lewis oesophagectomy. AL was confined to the neck in 26 (51%) patients and managed conservatively. Mediastinal leaks were managed with CT-guided drainage (15 patients), endoscopic vacuum therapy (4 patients) and surgical re-exploration (7patients) which led to prolonged hospital stay of 17 days (IQR:14-24). Post-operative morbidity (Clavien-Dindo 3 and higher) occurred in 28 (55%) patients and mortality in 6 (12%). Subsequent strictures developed in 20 patients (40%) who required a median of 4 oesophageal dilatations in the first post-operative year. After a median follow-up of 19 months, 11 (22%) patients recurred, most (9) with distant metastases. The median overall survival of the cohort was 56months and 5-yr survival rate was 47%. There was no significant survival difference in patients with or without AL(p>0.5). Conclusion Anastomotic leak after oesophagectomy was associated with worse short-term outcomes like prolonged hospital stay (17 vs 12 days) and stricture rates (40% vs 8.8%) but not statistically significant difference in long-term survival when compared to patients without leak. Further large-scale studies have to be done to analyse the long-term impact of advances in endoscopic management techniques of anastomotic leak.