146 Prophylactic Endoluminal Vacuum Therapy (pEVT): Towards an Era of Reducing Leak Related Morbidity After High-Risk Elective Oesophago-Gastric Surgery

Abstract Background Leaks following oesophago-gastric (OG) surgery result in sepsis and increased mortality. Their management is challenging and associated with high morbidity and extended recovery times; preventing the systemic impact could improve outcomes and negate the need for invasive procedures. Prophylactic Endoluminal Vacuum Therapy (pEVT), placed across the anastomosis intra-operatively, minimises the clinical impact of an anastomotic breakdown, by preventing the leakage of gastrointestinal contents into the mediastinum. Method 30 high-risk patients undergoing elective OG Cancer surgery (March’21 – January’25) were prospectively identified. pEVT was initiated at the surgeon’s discretion. The primary outcome was 30-day anastomotic leak (AL) rate; secondary outcomes included hospital-acquired pneumonia (HAP) and length of stay. A 1:3 propensity-score-matched analysis compared 30 pEVT patients who underwent a resection for OG cancer to historical controls, matched on age, Charlson Comorbidity Index, anaesthetic assessment, and surgical approach. Covariate balance and outcomes were analysed using standardised mean differences, Fisher’s exact, and Wilcoxon rank-sum tests. Results Technical success was achieved in all patients; there were no complications related to the insertion or removal of the device. The median duration of pEVT was 6 days (range: 4 - 16). Compared to controls, the pEVT group had significantly lower: 30-day AL rate (p=0.036), incidence of HAP (p=0.046), shorter ICU stay (p=0.006) and shorter total hospital stay (p=0.038). Conclusions pEVT can be delivered safely and significantly improves post-operative outcomes in high-risk patients undergoing OG cancer resection surgery. These findings support the use of pEVT as an adjunct to surgery in this group, and warrants further investigation in larger, multicentre studies.