ABSTRACT
INTRODUCTION: For treatment of Esophagectomy Complications Consensus Group (ECCG) type II leak, self-expanding metal stents (SEMS) can be placed, or endoscopic vacuum therapy (EVT) can be applied;however, there are no prospective data concerning the optimal endoscopic treatment strategy. The aim of the study was to report outcomes of treatment strategies for patients with an ECCG type II anastomotic leak after robotic-assisted minimally invasive esophagectomy (RAMIE). METHOD(S): All patients who developed an ECCG type II anastomotic leak since the introduction of RAMIE at our high-volume center (>200 cases/y) were included in the analysis. Time to EVT, duration of EVT, and follow-up treatment were analyzed for all patients. RESULT(S): Since 2017, a total of 157 patients have undergone a RAMIE at our clinic. Twenty-three patients developed an ECCG type II anastomotic leak (14.6% leak rate). Successful completion was achieved in 21 of 23 of patients (91%). Two patients were deceased before the completion of endoscopic therapy: 1 of unrelated COVID-19 pneumonia and 1 of sepsis with unknown focus. Mean duration of EVT was12 days (range 4 to 28 days), mean of 2 endoscopic sponge changes (range 0 to 5). Anastomotic leak was diagnosed at a mean of 9 days postoperative (range 2 to 19 days). Placement of a SEMS was performed in 5 patients (24%) after completion of EVT. No patient needed conversion to operative therapy;however, pre-emptive EVT was performed after surgical revision in 3 patients (37.5%) with an ECCG type III leak. CONCLUSION(S): EVT has been shown to be a safe and successful treatment option for anastomotic leak after robotic-assisted esophagectomy with success rate of 91% in our cohort. No additional surgical revision was performed in any patient.