Objective:

To evaluate the incidence of anastomotic leak (AL) following Ivor-Lewis esophagectomy, focusing on perioperative fluid balance, intraoperative blood pressure control, and vasopressor strategies, and to assess their significance in improving patient outcomes.

Key Findings:

• Anastomotic leak rates historically range from 5 to 30%, with contemporary estimates between 9 and 11%, highlighting the ongoing challenge of this complication.
• Individualized, goal-directed fluid management is associated with lower AL rates (5-9%) compared to liberal fluid replacement, suggesting a need for tailored approaches.
• Intraoperative vasopressor strategies may impact conduit perfusion and thus influence AL risk, indicating a potential area for clinical intervention.

Interpretation:

The study highlights the importance of perioperative fluid and hemodynamic management in reducing the risk of anastomotic leakage following esophagectomy, with implications for improving surgical outcomes.

Limitations:

• Retrospective design may introduce selection bias, potentially affecting the reliability of the findings.
• Single-center study limits generalizability of findings, suggesting the need for multi-center validation.
• Potential confounding factors not fully accounted for may influence the observed associations.

Conclusion:

Identifying modifiable factors related to fluid management and vasopressor use may help reduce the incidence of anastomotic leakage and improve postoperative outcomes in esophagectomy patients, warranting further research in these areas.