Leakage of intrathoracic oesophagovisceral anastomoses in adenocarcinoma of the gastric cardia: Changes in serial APACHE II scores and their prognostic significance

Huei Jyh Fahn, Liang Shun Wang, Mu Shun Huang, Biing Shiun Huang, Wen Hu Hsu, Min Hsiung Huang

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective: To evaluate changes in serial Acute Physiology and Chronic Health Evaluation (APACHE) II scores in patients with intrathoracic oesophageal anastomotic leaks and to assess their prognostic significance. Design: Retrospective study. Setting: Teaching hospital, Taiwan. Subjects: 18 patients (4%) who developed intrathoracic oesophageal anastomotic leaks in a total of 491 patients who underwent oesophagogastrectomy for adenocarcinoma of the gastric cardia between 1980 and 1994. Main outcome measure: APACHE II scores in those that survived (n = 10) compared with those who died (n = 8). Results: Of the 18 patients, 8 (44%) died. The preoperative general condition, biochemical data, and perioperative APACHE II scores were similar in the two groups. Leakage from the oesophageal anastomoses caused similar degrees of sepsis in the two groups in terms of APACHE II scoring, but the APACHE II scores of survivors started to decline within a week of initial management. In contrast, the APACHE II scores of those who died had increased one week after the leak had been diagnosed despite initial management. There were significant differences in the APACHE II scores of survivors and those who died from one week after leakage until discharge or death (p <0.001). Only one patient (1/9) survived if the APACHE II score one week after diagnosis of the leak was more than 10. None died of the leak if the APACHE II scores were equal to or less than 10 after a week. Conclusions: Adequate surgical drainage, antibiotic cover according to the microbiological picture, and nutritional support are essential in the management of intrathoracic oesophageal fistulas. Early reoperation to close early leaks by simple suture or secondary wrapping and to improve local drainage is recommended. The APACHE II scoring system is valuable in evaluating the severity of sepsis caused by intrathoracic oesophagovisceral anastomosis leaks and may serve as an indicator of adequate management. Aggressive surgical measures should be considered if APACHE II scores rise during initial management.

Original languageEnglish
Pages (from-to)345-350
Number of pages6
JournalEuropean Journal of Surgery, Acta Chirurgica
Volume163
Issue number5
Publication statusPublished - 1997
Externally publishedYes

Fingerprint

Cardia
APACHE
Stomach
Adenocarcinoma
Anastomotic Leak
Survivors
Drainage
Sepsis
Esophageal Fistula
Nutritional Support
Taiwan
Reoperation
Teaching Hospitals
Sutures
Retrospective Studies
Outcome Assessment (Health Care)
Anti-Bacterial Agents

Keywords

  • anastomosis
  • APACHE II
  • gastrectomy
  • Oesophagus

ASJC Scopus subject areas

  • Surgery

Cite this

Leakage of intrathoracic oesophagovisceral anastomoses in adenocarcinoma of the gastric cardia : Changes in serial APACHE II scores and their prognostic significance. / Fahn, Huei Jyh; Wang, Liang Shun; Huang, Mu Shun; Huang, Biing Shiun; Hsu, Wen Hu; Huang, Min Hsiung.

In: European Journal of Surgery, Acta Chirurgica, Vol. 163, No. 5, 1997, p. 345-350.

Research output: Contribution to journalArticle

Fahn, Huei Jyh ; Wang, Liang Shun ; Huang, Mu Shun ; Huang, Biing Shiun ; Hsu, Wen Hu ; Huang, Min Hsiung. / Leakage of intrathoracic oesophagovisceral anastomoses in adenocarcinoma of the gastric cardia : Changes in serial APACHE II scores and their prognostic significance. In: European Journal of Surgery, Acta Chirurgica. 1997 ; Vol. 163, No. 5. pp. 345-350.
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abstract = "Objective: To evaluate changes in serial Acute Physiology and Chronic Health Evaluation (APACHE) II scores in patients with intrathoracic oesophageal anastomotic leaks and to assess their prognostic significance. Design: Retrospective study. Setting: Teaching hospital, Taiwan. Subjects: 18 patients (4{\%}) who developed intrathoracic oesophageal anastomotic leaks in a total of 491 patients who underwent oesophagogastrectomy for adenocarcinoma of the gastric cardia between 1980 and 1994. Main outcome measure: APACHE II scores in those that survived (n = 10) compared with those who died (n = 8). Results: Of the 18 patients, 8 (44{\%}) died. The preoperative general condition, biochemical data, and perioperative APACHE II scores were similar in the two groups. Leakage from the oesophageal anastomoses caused similar degrees of sepsis in the two groups in terms of APACHE II scoring, but the APACHE II scores of survivors started to decline within a week of initial management. In contrast, the APACHE II scores of those who died had increased one week after the leak had been diagnosed despite initial management. There were significant differences in the APACHE II scores of survivors and those who died from one week after leakage until discharge or death (p <0.001). Only one patient (1/9) survived if the APACHE II score one week after diagnosis of the leak was more than 10. None died of the leak if the APACHE II scores were equal to or less than 10 after a week. Conclusions: Adequate surgical drainage, antibiotic cover according to the microbiological picture, and nutritional support are essential in the management of intrathoracic oesophageal fistulas. Early reoperation to close early leaks by simple suture or secondary wrapping and to improve local drainage is recommended. The APACHE II scoring system is valuable in evaluating the severity of sepsis caused by intrathoracic oesophagovisceral anastomosis leaks and may serve as an indicator of adequate management. Aggressive surgical measures should be considered if APACHE II scores rise during initial management.",
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AU - Hsu, Wen Hu

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