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Background: The incidence of cervical anastomotic leak after transhiatal esophagectomy for carcinoma esophagus has traditionally been high at around 20%. The severity ranges from asymptomatic minor defects to more fulminant leaks causing sepsis and multi organ failure. Surgery is still the mainstay of treatment. Squamous cell carcinoma forms the dominant histology worldwide with adenocarcinoma showing an upward trend. We sought to determine the incidence and management of cervical esophageal leaks after esophagectomy for cancer of esophagus in our centre. Material and Methods: Between January 2012 to December 2015 ,143 patients with cancer of esophagus were operated all of whom underwent transhiatal esophagectomy. All patients had surgical resection chosen as primary treatment. Gut continuity was restored by using a stomach tube. A preoperative histopathology of lesion was carried out to determine the type of tumor. A contrast computer tomography (CT) scan of chest and abdomen helped establish the extent of growth. A methylene blue test was done followed by a contrast conray swallow. Patients were categorised in early and late leak group with each group having patients with mild, moderate and severe leak. Results: Of 143 patients, 17 had cervical anastomotic leak of which 12 were males and 5 females. Twenty nine percent had early and 71% late leak . Ten patients had mild, 6 moderate and 1 severe leak. The patient with severe leak died on 11 th postoperative day. Of remaining 16 leaked patients, methylene blue and conray swallow together detected the leaks, all of which healed by conservative measures. Patients in cervical leak group had stricture rate of 29%. Conclusion: Cervical leaks after esophagectomy remain a significant morbidity. The need for conservative treatment and surgical intervention should be carefully weighed as per severity of leak and general condition of the patient. Postoperative optimization of nutritional status and through appraisal of surgical wounds helps to prevent and identify leaks earlier.

Incidence and management of cervical anastomotic leak after transhiatal esophagectomy for cancer esophagus