{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T16:42:32Z","timestamp":1786207352890,"version":"build-2736575974"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum M\u00fcnster"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anastomotic leakage (AL) remains one of the most feared complications after esophagectomy. Preemptive endoscopic vacuum therapy (pEVT) has been proposed to support anastomotic healing, but robust clinical data remain limited. This study aimed to evaluate the role of pEVT in the management of AL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study analyzed 116 esophageal cancer patients who experienced AL after Ivor Lewis esophagectomy between 2012 and 2023. The patients were categorized into two groups: those who received therapeutic EVT (tEVT) after AL diagnosis without prior pEVT and those who experienced AL despite receiving pEVT and subsequently required tEVT as well. Clinical outcomes, leak severity, and hospital metrics were compared with a focus on endoscopic management of AL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The patients in the pEVT group presented with significantly less severe leaks (ZACC grade II: 36.7% vs. 5.4%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), required less intracavitary therapy (43.4% vs. 67.9%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.027), and exhibited lower postoperative inflammation. Preemptive EVT was independently associated with favorable leak grading (odds ratio, 14.4;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.004), a 69% reduced need for intracavitary treatment (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.027), and markedly shorter intensive care unit (ICU: \u221274.4%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and hospital (\u221227.5%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.011) stays. The overall healing rate was high in both groups (pEVT: 85%; non-pEVT: 80.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preemptive EVT significantly reduces the clinical severity of AL and facilitates faster recovery by shortening ICU and hospital stays. These findings highlight its value as a preventive strategy for high-risk patients undergoing esophagectomy. Prospective studies are needed to validate these promising results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19622-0","type":"journal-article","created":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T18:27:04Z","timestamp":1776018424000},"page":"7989-7998","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improved Clinical Outcomes in Anastomotic Leak Management Using Preemptive Endoscopic Vacuum Therapy After Esophagectomy"],"prefix":"10.1245","volume":"33","author":[{"given":"Jennifer","family":"Merten","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus Karl","family":"Kostka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Szardenings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens Peter","family":"H\u00f6lzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen A.","family":"Juratli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader","family":"El-Sourani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Pascher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Kathrin","family":"Eichelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"19622_CR1","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1097\/SLA.0000000000002445","volume":"266","author":"HM Schmidt","year":"2017","unstructured":"Schmidt HM, Gisbertz SS, Moons J, et al. Defining benchmarks for transthoracic esophagectomy: a multicenter analysis of total minimally invasive esophagectomy in low-risk patients. Ann Surg. 2017;266:814\u201321. https:\/\/doi.org\/10.1097\/SLA.0000000000002445.","journal-title":"Ann Surg"},{"key":"19622_CR2","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1093\/bjs\/znac016","volume":"109","author":"Oesophago-Gastric Anastomotic Audit C","year":"2022","unstructured":"Oesophago-Gastric Anastomotic Audit C. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg. 2022;109:439\u201349. https:\/\/doi.org\/10.1093\/bjs\/znac016.","journal-title":"Br J Surg"},{"issue":"649\u2013658","key":"19622_CR3","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.1053\/j.gastro.2022.05.054","volume":"163","author":"E Morgan","year":"2022","unstructured":"Morgan E, Soerjomataram I, Rumgay H, et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: new estimates from GLOBOCAN 2020. Gastroenterology. 2022;163(649\u2013658):e2. https:\/\/doi.org\/10.1053\/j.gastro.2022.05.054.","journal-title":"Gastroenterology"},{"key":"19622_CR4","doi-asserted-by":"publisher","first-page":"2447","DOI":"10.1007\/s11605-021-04955-w","volume":"25","author":"AK Eichelmann","year":"2021","unstructured":"Eichelmann AK, Ismail S, Merten J, et al. Economic burden of endoscopic vacuum therapy compared to alternative therapy methods in patients with anastomotic leakage after esophagectomy. J Gastrointest Surg. 2021;25:2447\u201354. https:\/\/doi.org\/10.1007\/s11605-021-04955-w.","journal-title":"J Gastrointest Surg"},{"key":"19622_CR5","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1007\/s13304-022-01265-x","volume":"74","author":"O Adamenko","year":"2022","unstructured":"Adamenko O, Ferrari C, Seewald S, Schmidt J. Prophylactic endoluminal vacuum therapy after major gastrointestinal surgery: a systematic review. Updates Surg. 2022;74:1177\u201386. https:\/\/doi.org\/10.1007\/s13304-022-01265-x.","journal-title":"Updates Surg"},{"key":"19622_CR6","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1097\/SLA.0000000000005125","volume":"274","author":"PC M\u00fcller","year":"2021","unstructured":"M\u00fcller PC, Morell B, Vetter D, et al. Preemptive endoluminal vacuum therapy to reduce morbidity after minimally invasive Ivor Lewis esophagectomy: including a novel grading system for postoperative endoscopic assessment of GI-anastomoses. Ann Surg. 2021;274:751\u20137. https:\/\/doi.org\/10.1097\/SLA.0000000000005125.","journal-title":"Ann Surg"},{"key":"19622_CR7","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1002\/ueg2.12523","volume":"12","author":"R Porschen","year":"2024","unstructured":"Porschen R, Fischbach W, Gockel I, et al. Updated German guideline on diagnosis and treatment of squamous cell carcinoma and adenocarcinoma of the esophagus. United Eur Gastroenterol J. 2024;12:399\u2013411. https:\/\/doi.org\/10.1002\/ueg2.12523.","journal-title":"United Eur Gastroenterol J"},{"key":"19622_CR8","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.surg.2024.05.023","volume":"176","author":"JP Hoelzen","year":"2024","unstructured":"Hoelzen JP, Fortmann L, Roy D, et al. Robotic-assisted esophagectomy with total mesoesophageal excision enhances R0-resection in patients with esophageal cancer: a single-center experience. Surgery. 2024;176:721\u20139. https:\/\/doi.org\/10.1016\/j.surg.2024.05.023.","journal-title":"Surgery"},{"key":"19622_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/dote.12459","volume":"30","author":"K Lindner","year":"2017","unstructured":"Lindner K, Lubbe L, Muller AK, Palmes D, Senninger N, Hummel R. Potential risk factors and outcomes of fistulas between the upper intestinal tract and the airway following Ivor Lewis esophagectomy. Dis Esophagus. 2017;30:1\u20138. https:\/\/doi.org\/10.1111\/dote.12459.","journal-title":"Dis Esophagus"},{"key":"19622_CR10","doi-asserted-by":"publisher","first-page":"743266","DOI":"10.3389\/fsurg.2021.743266","volume":"8","author":"H Li","year":"2021","unstructured":"Li H, Zhuang S, Yan H, Wei W, Su Q. Risk factors of anastomotic leakage after esophagectomy with intrathoracic anastomosis. Front Surg. 2021;8:743266. https:\/\/doi.org\/10.3389\/fsurg.2021.743266.","journal-title":"Front Surg"},{"key":"19622_CR11","doi-asserted-by":"publisher","first-page":"5688","DOI":"10.3390\/jcm12175688","volume":"12","author":"AK Peters","year":"2023","unstructured":"Peters AK, Juratli MA, Roy D, et al. Factors influencing postoperative complications following minimally invasive Ivor Lewis esophagectomy: a retrospective cohort study. J Clin Med. 2023;12:5688. https:\/\/doi.org\/10.3390\/jcm12175688.","journal-title":"J Clin Med"},{"key":"19622_CR12","doi-asserted-by":"publisher","first-page":"089","DOI":"10.1093\/dote\/doz089","volume":"33","author":"SK Kamarajah","year":"2020","unstructured":"Kamarajah SK, Lin A, Tharmaraja T, et al. Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis. Dis Esophagus. 2020;33:089. https:\/\/doi.org\/10.1093\/dote\/doz089.","journal-title":"Dis Esophagus"},{"key":"19622_CR13","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1245\/s10434-021-10734-3","volume":"29","author":"RT van Kooten","year":"2022","unstructured":"van Kooten RT, Voeten DM, Steyerberg EW, et al. Patient-related prognostic factors for anastomotic leakage, major complications, and short-term mortality following esophagectomy for cancer: a systematic review and meta-analyses. Ann Surg Oncol. 2022;29:1358\u201373. https:\/\/doi.org\/10.1245\/s10434-021-10734-3.","journal-title":"Ann Surg Oncol"},{"key":"19622_CR14","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.athoracsur.2024.12.019","volume":"119","author":"AL Axtell","year":"2025","unstructured":"Axtell AL, Angeles C, McCarthy DP, Maloney JD, Leverson GE, DeCamp MM. Anastomotic leak after esophagectomy: analysis of the STS general thoracic surgery database. Ann Thorac Surg. 2025;119:796\u2013804. https:\/\/doi.org\/10.1016\/j.athoracsur.2024.12.019.","journal-title":"Ann Thorac Surg"},{"key":"19622_CR15","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/j.gassur.2024.02.003","volume":"28","author":"E Van Daele","year":"2024","unstructured":"Van Daele E, Vanommeslaeghe H, Peirsman L, Van Nieuwenhove Y, Ceelen W, Pattyn P. Early postoperative systemic inflammatory response as predictor of anastomotic leakage after esophagectomy: a systematic review and meta-analysis. J Gastrointest Surg. 2024;28:757\u201365. https:\/\/doi.org\/10.1016\/j.gassur.2024.02.003.","journal-title":"J Gastrointest Surg"},{"key":"19622_CR16","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s00423-025-03617-8","volume":"410","author":"C Popa","year":"2025","unstructured":"Popa C, Schlanger D, Aiolfi A, et al. Biomarkers associated with anastomotic leakage after esophagectomy: a systematic review. Langenbecks Arch Surg. 2025;410:55. https:\/\/doi.org\/10.1007\/s00423-025-03617-8.","journal-title":"Langenbecks Arch Surg"},{"key":"19622_CR17","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1055\/s-0042-123188","volume":"49","author":"PA Neumann","year":"2017","unstructured":"Neumann PA, Mennigen R, Palmes D, Senninger N, Vowinkel T, Laukoetter MG. Pre-emptive endoscopic vacuum therapy for treatment of anastomotic ischemia after esophageal resections. Endoscopy. 2017;49:498\u2013503. https:\/\/doi.org\/10.1055\/s-0042-123188.","journal-title":"Endoscopy"},{"key":"19622_CR18","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1093\/dote\/doy126","volume":"32","author":"C Gubler","year":"2019","unstructured":"Gubler C, Vetter D, Schmidt HM, et al. Preemptive endoluminal vacuum therapy to reduce anastomotic leakage after esophagectomy: a game-changing approach? Dis Esophagus. 2019;32:126. https:\/\/doi.org\/10.1093\/dote\/doy126.","journal-title":"Dis Esophagus"},{"key":"19622_CR19","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1080\/13645706.2022.2051719","volume":"31","author":"SH Chon","year":"2022","unstructured":"Chon SH, Berlth F, Dratsch T, et al. Outcome of prophylactic endoscopic vacuum therapy for high-risk anastomosis after esophagectomy. Minim Invasive Ther Allied Technol. 2022;31:1079\u201385. https:\/\/doi.org\/10.1080\/13645706.2022.2051719.","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"19622_CR20","doi-asserted-by":"publisher","first-page":"e2129228","DOI":"10.1001\/jamanetworkopen.2021.29228","volume":"4","author":"MA Mederos","year":"2021","unstructured":"Mederos MA, de Virgilio MJ, Shenoy R, et al. Comparison of clinical outcomes of robot-assisted, video-assisted, and open esophagectomy for esophageal cancer: a systematic review and meta-analysis. JAMA Netw Open. 2021;4:e2129228. https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.29228.","journal-title":"JAMA Netw Open."},{"key":"19622_CR21","doi-asserted-by":"publisher","first-page":"7","DOI":"10.29337\/ijsp.24","volume":"25","author":"PC Muller","year":"2021","unstructured":"Muller PC, Vetter D, Kapp JR, et al. Pre-emptive endoluminal negative pressure therapy at the anastomotic site in minimally invasive transthoracic esophagectomy (the preSPONGE trial): study protocol for a multicenter randomized controlled trial. Int J Surg Protoc. 2021;25:7\u201315. https:\/\/doi.org\/10.29337\/ijsp.24.","journal-title":"Int J Surg Protoc"},{"key":"19622_CR22","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s11701-024-01880-3","volume":"18","author":"R Perry","year":"2024","unstructured":"Perry R, Barbosa JP, Perry I, Barbosa J. Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients. J Robot Surg. 2024;18:125. https:\/\/doi.org\/10.1007\/s11701-024-01880-3.","journal-title":"J Robot Surg"},{"key":"19622_CR23","doi-asserted-by":"publisher","first-page":"1348942","DOI":"10.3389\/fsurg.2024.1348942","volume":"11","author":"HI Tupper","year":"2024","unstructured":"Tupper HI, Roybal BO, Jackson RW, et al. The impact of minimally invasive esophagectomy operative duration on postoperative outcomes. Front Surg. 2024;11:1348942. https:\/\/doi.org\/10.3389\/fsurg.2024.1348942.","journal-title":"Front Surg"},{"key":"19622_CR24","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1002\/jso.25613","volume":"120","author":"BR Hall","year":"2019","unstructured":"Hall BR, Flores LE, Parshall ZS, Shostrom VK, Are C, Reames BN. Risk factors for anastomotic leak after esophagectomy for cancer: a NSQIP procedure-targeted analysis. J Surg Oncol. 2019;120:661\u20139. https:\/\/doi.org\/10.1002\/jso.25613.","journal-title":"J Surg Oncol"},{"key":"19622_CR25","doi-asserted-by":"publisher","first-page":"026","DOI":"10.1093\/dote\/doab026","volume":"35","author":"Y Han","year":"2022","unstructured":"Han Y, Zhang Y, Zhang W, et al. Learning curve for robot-assisted Ivor Lewis esophagectomy. Dis Esophagus. 2022;35:026. https:\/\/doi.org\/10.1093\/dote\/doab026.","journal-title":"Dis Esophagus"},{"key":"19622_CR26","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1056\/NEJMoa2032125","volume":"384","author":"RJ Kelly","year":"2021","unstructured":"Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384:1191\u2013203. https:\/\/doi.org\/10.1056\/NEJMoa2032125.","journal-title":"N Engl J Med"},{"key":"19622_CR27","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1056\/NEJMoa2409408","volume":"392","author":"J Hoeppner","year":"2025","unstructured":"Hoeppner J, Brunner T, Schmoor C, et al. Perioperative chemotherapy or preoperative chemoradiotherapy in esophageal cancer. N Engl J Med. 2025;392:323\u201335. https:\/\/doi.org\/10.1056\/NEJMoa2409408.","journal-title":"N Engl J Med"},{"key":"19622_CR28","doi-asserted-by":"publisher","first-page":"089","DOI":"10.1093\/dote\/doab089","volume":"35","author":"Z Jin","year":"2022","unstructured":"Jin Z, Zhang J, Chen D, et al. Neoadjuvant chemoradiotherapy, chemotherapy, and radiotherapy do not significantly increase the incidence of anastomotic leakage after esophageal cancer surgery: a meta-analysis. Dis Esophagus. 2022;35:089. https:\/\/doi.org\/10.1093\/dote\/doab089.","journal-title":"Dis Esophagus"},{"key":"19622_CR29","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1111\/jebm.12634","volume":"17","author":"D Zhou","year":"2024","unstructured":"Zhou D, Chen D, Song P, et al. Does neoadjuvant therapy contribute to increased risk in anastomotic leakage of esophageal cancer? A network meta-analysis. J Evid Based Med. 2024;17:559\u201374. https:\/\/doi.org\/10.1111\/jebm.12634.","journal-title":"J Evid Based Med"}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19622-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-026-19622-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19622-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T15:48:41Z","timestamp":1786204121000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-026-19622-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,12]]},"references-count":29,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["19622"],"URL":"https:\/\/doi.org\/10.1245\/s10434-026-19622-0","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,12]]},"assertion":[{"value":"28 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Jennifer Merten, Markus Karl Kostka, Carsten Szardenings, Jens Peter H\u00f6lzen, Mazen A. Juratli, Nader El-Sourani, Andreas Pascher, and Ann-Kathrin Eichelmann declare they have no competing interests that may be relevant to the contents of this article. We have not received any financial or material support.","order":1,"name":"Ethics","label":"Disclosure","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"All authors contributed to the article and approved the submitted version.","order":2,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Ethics"}}]}}