Complicated Postoperative Course After MIE Ivor-Lewis for GEJ Adenocarcinoma

12 Nov 2025 16:00 17:30
Amsterdam
Suzanne Gisbertz  Host

Patient Profile & Initial Diagnosis

  • Patient: 72-year-old patient

  • WHO Performance Score: 0

  • BMI: 22 kg/m2

  • Medical History: History of coronary stent for occlusive coronary heart disease at 52.

  • Diagnosis: cT3N2M0 moderately differentiated GEJ adenocarcinoma (38-44 cm), with 3 cm ingrowth into the cardia.

Course of Treatment

  • Neoadjuvant Treatment: FLOT.

  • Surgery: MIE Ivor-Lewis with gastric reconstruction using circular stapled anastomosis.

  • Postoperative Complication: Complicated postoperative course with recurrent anastomotic leakage and decreasing number of potential solutions.

Surgery

Procedure: Uncomplicated MIE Ivor-Lewis with gastric reconstruction.

CT Scan POD 4

Confirmed anastomotic leakage with collections along the conduit and left pleural effusion.

Endoscopy POD 5

Primary defect in the circular staple line.

Initial Treatment

Initial treatment consisted of VAC-stent.

Clinical Course

Clinical improvement until POD 16...

CT Scan POD 16

Recurrent anastomotic leakage with decreasing number of potential solutions.

Panel for Discussion

Suzanne Gisbertz (Amsterdam, The Netherlands) | Maria Bencivenga (Verona, Italy) | Peter Grimminger (Mainz, Germany) | Christian Gutschow (Zurich, Switzerland) | Lucas Duits (Amsterdam, The Netherlands)

Topics for Discussion

  1. Prophylactic Treatments: Prophylactic treatments to prevent anastomotic leakage.

  2. Optimal Initial Treatment: Optimal initial treatment of anastomotic leakage.

  3. Last Resort Options: Last resort options for persistent anastomotic leakage.

  4. Future Options: Future options for similar cases.