748. CAUSES, TREATMENT AND OUTCOMES OF CONDUIT NECROSIS FOLLOWING OESOPHAGECTOMY: A SINGLE CENTRE RETROSPECTIVE STUDY

Abstract Background Conduit necrosis (CN) following esophagectomy is a poorly described entity associated with high morbidity and mortality. Identifying factors associated with CN would help stratify patients at risk of this devastating complication. Furthermore, describing the outcomes of various treatment options may aid in personalising treatment to maximise the chance of recovery. The aim of this study was to describe the causes, treatment and outcomes of CN following esophagectomy. Methodology Between 01/2006 and 12/2023, a single centre retrospective review of a prospectively maintained comprehensive oesophageal cancer surgical database was performed. Complications data from the online Canadian Thoracic Surgery Quality Improvement Program was also utilized. All patients with oesophageal and junctional cancer who underwent transthoracic en bloc surgical resection were included. Defined as circumferential ischaemia of the neo-esophageal conduit identified on postoperative endoscopy, patients with CN were identified. Clinical and demographic data of these patients was compared to those with no documented history of conduit complications. The treatment and outcomes of CN were also recorded. Results Anastomotic leak occurred in 146/1043 patients (14.0%), CN in 39 (3.7%) and tracheo-oesophageal fistula in 7 (0.7%). Compared to the 853 patients without conduit complications, CN was associated with BMI >34.5kg/m2 (3/39 vs 15/853,p = 0.03), proximal lesions (5/39,12.9% vs 23/853,2.7%, p = 0.002) and McKeown oesophagogastrectomy (13/39,33.3% vs 125/853,14.7%, p=<0.001). Initially, endoscopic treatment, anastomotic refashioning, taking down the conduit and oesophagostomy was used in 14, 13, 8 and 4 patients (35.9%,33.3%,20.5% and 10.3%) with success rates of 7/14(50.0%), 6/13(46.2%), 4/8(50.0%), and 3/4(75.0%) respectively. The 90-day mortality of CN was 10.9% and associated with a prolonged hospital admission (median 46 vs 12 days, p=<0.001) Conclusion CN is an uncommon entity but associated with high morbidity, mortality and prolonged postoperative length of stay. Treatment decisions remain complex and whilst endoscopic management seems feasible, re-intervention is often required. Further understanding of how to improve salvage treatment in this unique cohort of patients is required.