P1.134. Pectoralis Major Flap and Stent Together to Salvage a Post Esophagectomy Anastomotic Leakage, a Case Report

Abstract

Abstract Topic Esophageal Cancer: Other Background Anastomotic leakage after Esophagectomy is often disastrous and difficult to manage. Here we present a case of 50 years old gentleman who suffer from Squamous cell cancer of esophagus with three phase esophagectomy performed, complicated with leakage that failed to be managed endoscopically with stenting and endosponge. Methods Stenting and then endosponge were first performed to manage the leak with poor response. As the patient was stable and fit clinically, we decided to re-operate for surgical repair. Resection of manubrium and clavicular head was performed with mediastinoscopic lavage. The repair was reinforceed with pectoralis major muscle flap to the defect. At the same time, covered esophageal stent was placed endoluminally aiming for a complete seal off. Results Patient was stabilized and chest condition improved. He was well to discharge to rehabilitation facility. On reassessment at week 10 after re-operation, the anastomosis was healed on OGD. Patient recovered from the surgery, tolerating oral diet. He had no disease recurrence up to 1 year. Conclusion Endoscopic management of post esophagectomy anastomotic leakage is still the first line treatment option. However it is not always successful. Surgical repair with vascularized muscle flap, for example in our case, pectoralis major muscle flap appeared promising when expertise available. It also provided protection to nearby vital organs and great vessels, making it a great salvage option when endoscopic management failed.