A clinical practice review: management strategies and emerging approaches for anastomotic leakage following radical surgery for esophageal cancer

Radical esophagectomy remains the cornerstone of curative treatment for esophageal cancer, but is frequently complicated by postoperative events, most notably anastomotic leakage. Anastomotic leakage, occurring in up to 30% of cases, is multifactorial in origin and significantly increases morbidity and mortality. This review aims to summarize current management strategies, highlight emerging therapies, and identify persistent clinical challenges related to this complication. Relevant studies were identified through targeted literature searches of articles focusing on clinical management, therapeutic innovation, and reported outcomes related to anastomotic leakage, with an emphasis on recent and high-impact publications. This review synthesizes current strategies for the detection, prevention, and management of anastomotic leakage and evaluates emerging interventions. Early diagnosis through contrast-enhanced computed tomography (CT) and esophagography is critical for improving outcomes. Conservative measures such as broad-spectrum antibiotics, nutritional support, and image-guided drainage remain the first-line approach, while surgical revision and endoscopic techniques like stenting and vacuum therapy are increasingly employed in complex cases. Novel therapies, including tissue-engineered constructs and biodegradable stents, are under development but lack large-scale clinical validation. Despite these advancements, major clinical challenges persist, including limited predictive tools for risk stratification, variability in treatment algorithms across institutions, and unclear long-term efficacy of newer interventions. Furthermore, most novel strategies are supported by small cohort studies or preclinical data, limiting their immediate clinical application. Therefore, improved multidisciplinary collaboration, standardized treatment protocols, and integration of predictive diagnostics are essential for optimizing outcomes. Future research should focus on validating emerging therapies through randomized clinical trials and developing personalized management algorithms based on patient-specific risk factors and leak characteristics.