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Ann Thorac Surg 2006;82:383-384
© 2006 The Society of Thoracic Surgeons

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Correspondence

Reply

Weill Medical College of Cornell University, 525 E 68th St, Suite M404, Box 110, New York, NY 10021

(Email: rjk2002{at}med.cornell.edu).

To the Editor:

We appreciate Dr. Heitmiller's [1] comments regarding our study [2] describing the intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy. In his letter he states that our conclusion from this study is that cervical anastomotic leaks are more common after esophagectomy with thoracotomy than after transhiatal esophagectomy. Furthermore he believes that cervical leaks occur more frequently when a thoracotomy is performed because of residual pneumothorax after chest tube removal.

In our article we made no conclusion comparing the rate of anastomotic leakage after either thansthoracic or transhiatal esophagectomy. Rather we concluded that intrathoracic manifestations occurred in 52% of patients with cervical anastomotic leaks in our series of patients who underwent transthoracic esophagectomy with cervical anastomosis. This figure is appreciably higher than that previously published for cervical anastomotic leaks after transhiatal esophagectomy. We then speculated as to the reasons why sepsis seems to spread more readily to the thoracic cavity despite placement of the anastomosis in the neck, and we surmised that it could be due to the more extensive dissection at the thoracic inlet, which is performed in patients who undergo thoracotomy compared with the transhiatal patients. In addition, an increase in negative intrathoracic pressure due to chest tube suction may be playing a role as well. In our patients, it is not uncommon for the chest tubes to remain in place for as much as 1 week after resection.

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1. Heitmiller RF. Intrathoracic manifestation of cervical anastomotic leaks (letter) Ann Thorac Surg 2006;82:383.[Free Full Text]
2. Korst RJ, Port JL, Lee PC, Altorki NK. Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma Ann Thorac Surg 2005;80:1185-1190.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert J. Korst Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Korst, R. J. Search for Related Content PubMed Articles by Korst, R. J. Related Collections Esophagus - cancer Related Article