383. A LONGITUDINAL STUDY OF ENDOSCOPIC NASO-LEAKAGE NEGATIVE PRESSURE DRAINAGE FOR ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY. (24th September 2022) - Liu, Xin-Yang
Abstract: Postoperative anastomotic leak is a threatening complication after esophagectomy. Recently, endoscopic naso-leakage negative pressure drainage has become a promising choice when satisfactory drainage could not be attained using chest drainage or other conservative therapies. This study aims to evaluate the efficacy of endoscopic naso-leakage negative pressure drainage for anastomotic leak by longitudinal analyses, so as to focus on the intra-individual changes associated with the drainage in the disease course and to minimize the between-subjects variations. We conducted a retrospective longitudinal study based on patients who were diagnosed with anastomotic leak after esophagectomy and treated with endoscopic naso-leakage negative pressure drainage in Zhongshan Hospital Fudan University, from 2018 to 2021. We hypothesize that maximum temperature (Tmax), maximum heart rate (HRmax), White blood cell count (WBC), and C reactive protein (CRP) had a two-piece linear spline growth curve with a notch at the time of drainage. Linear mixed-effects regressions were used to test the hypothesis of whether endoscopic naso-leakage negative pressure drainage changed the pattern of development of these clinical parameters with time. Thirty patients were included, among which 83.3% were male, with a median age of 77 years. The median postoperative time to drainage was 16.5 days (range 6–66). Observations for Tmax, HRmax, WBC and CRP were 1366, 1372, 394, and 296, respectively. After adjusting for age, sex and body mass index, Tmax, HRmax, WBC and CRP showed similar pattern. There was no significant change over time before naso-leakage negative pressure drainage, while the four parameters all decreased significantly over time after naso-leakage negative pressure drainage. There was no overlap of the confidence intervals of slopes before and after drainage. (Table). The slope over time of Tmax, HRmax, WBC and CRP changed significantly after naso-leakage negative pressure drainage. Naso-leakage negative pressure drainage brought gradual decrease of these inflammatory parameters and could serve as a promising management for postoperative anastomotic leak after esophagectomy.