324 INTRALUMINAL CONTINUOUS DECOMPRESSION USING A COMPUTER-CONTROLLED PORTABLE VACUUM PUMP FOR CONTROLLING CERVICAL ANASTOMOTIC LEAKAGE AFTER SUBTOTAL ESOPHAGECTOMY

Abstract Anastomotic leakage is one of the major complications that can occur after an esophagectomy. Usually, preemptive surgical intervention with prompt open drainage by cervical incision is the first choice. In our department, on the other hand, we perform intraluminal continuous decompression (ILCD) using a computer-controlled portable vacuum pump system (Thopaz®) as first-line therapy for leakage of the cervical anastomosis. In this study, we examine the effectiveness of this management. Methods Thirty-eight patients who underwent esophagectomy and cervical anastomosis and were diagnosed with leakage between May 2005 and October 2019, were studied. Until July 2014, cervical incision was generally performed, and ILCD or nasoesophageal extraluminal drainage (NEED) was added in some cases (conventional group). Since August 2014, we have performed ILCD and have added NEED in patients for whom ILCD was ineffective. A cervical incision was made for refractory cases (ILCD group). These two groups were analyzed statistically. Fifteen (39.5%) of the 38 patients were treated as the conventional group, and the remaining 23 (60.5%) were treated as the ILCD group. Results Thirteen patients in the conventional group (86.7%) required a cervical incision. Eight patients in the ILCD group (34.8%) underwent cervical incision and 9 (39.1%) underwent NEED. Drinking water orally was resumed at a median (range) of 35 (6–284) days from leakage in the conventional group and 18 (0–111) days from leakage in the ILCD group. The time to oral drinking was significantly shorter in the ILCD group (p = 0.0365). Six patients in the conventional group (40%) and one patient in the ILCD group (4.3%) had Clavien-Dindo IIIb or higher complications, indicating a significantly lower rate in the ILCD group (p = 0.0096). Conclusion The ILCD as first-line therapy is a minimally invasive treatment that effectively prevents exacerbation of leakage after subtotal esophagectomy.