Table 2.

Overview of the postoperative management strategies and options for cervical and intrathoracic anastomotic leakage, emerging from the literature review

Site	Symptoms	Therapy	Management
Cervical	Asymptomatic or minimally symptomatic	Conservative	✓ Nil-per-mouth ✓ Enteral nutrition through feeding tube ✓ Opening cervical wound and cleaning with isotonic fluid ± Nasogastric tube ± Antibiotic treatment ± Percutaneous drainage (pleura or mediastinum)
	Symptomatic with local symptoms (neck inflammation)	Conservative	✓ Nil-per-mouth ✓ Enteral nutrition through feeding tube ✓ Opening cervical wound and clearing with isotonic fluid ✓ Percutaneous drainage (pleura or mediastinum) ✓ Nasogastric tube ✓ Antibiotic treatment
	Early leakage	Surgery	• Without ischemia ✓ Preserve gastric tube and suture defects ± Muscle flap repair • With local ischemia ✓ Resection of the ischemic area plus reanastomosis ± Muscle flap repair
	Uncontrolled sepsis	Surgery	✓ Resection of gastric tube plus creation of cervical esophagostomy ✓ Preserve gastric tube and suture defects ✓ Muscle flap repair
	Necrosis	Surgery	✓ Resection of gastric tube plus creation of cervical esophagostomy
	Intrathoracic symptoms	See below: intrathoracic anastomosis
Intrathoracic	Asymptomatic or minimally symptomatic	Conservative	✓ Nil-per-mouth ✓ Enteral nutrition (see above) ✓ Nasogastric tube ✓ Antibiotic treatment ± Percutaneous drainage (pleura or mediastinum)
	Symptomatic and/or with controlled sepsis	Drainage +/− Endoscopy	• Healthy AL margins and/or size <15 mm: ✓ Clip or sealant ± drainage ✓ or EVAC ✓ or STENT plus drainage • Inflamed/unhealthy AL margins and/or size >15 mm: ✓ EVAC ✓ or STENT plus drainage
	Early leakage	Surgery	• Without or local ischemia ✓ Thoracotomy, washing plus drainage ✓ Resection of ischemic area plus reanastomosis ± Muscle flap repair
	Uncontrolled sepsis or necrosis see above, split	Surgery	✓ Resection of gastric tube plus creation of cervical esophagostomy

✓ Suggested treatment ± optional treatment.