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Anastomotic leak is an important cause of morbidity and mortality after esophagectomy. Few studies have targeted risk factors for the development of leak after esophagectomy. The purpose of this study is to use The Society of Thoracic Surgeons Database to identify variables associated with leak after esophagectomy.The Society of Thoracic Surgeons Database was queried for patients treated with esophagectomy for esophageal cancer between 2001 and 2011. Univariate and multivariate analysis of variables associated with an increased risk anastomotic leak was performed.There were 7,595 esophagectomies, with 804 (10.6%) leaks. Thirty-day mortality and length of stay were higher for patients with anastomotic leak. Mortality in patients requiring surgical management was 11.6% (38 of 327) compared with 4.4% (20 of 458) in medically managed leaks (p0.001). The leak rate was higher in patients with cervical anastomosis compared with those with intrathoracic anastomoses, 12.3% versus 9.3%, respectively (p = 0.006). There was no difference in leak-associated mortality between the two approaches. Factors associated with leak on univariate analysis include obesity, heart failure, coronary disease, vascular disease, hypertension, steroids, diabetes, renal insufficiency, tobacco use, procedure duration greater than 5 hours, and type of procedure (p0.05). Multivariable regression analysis associated heart failure, hypertension, renal insufficiency, and type of procedure as risk factors for the development of leak (p0.05).Anastomotic leak after esophagectomy is an important cause of postoperative mortality and increased length of stay. We have identified important risk factors for the development of esophageal anastomotic leak after esophagectomy. Further studies aimed at risk reduction are warranted.

In summary, patients with N2 disease constitute a heterogeneous population with differing treatments and prognoses. Subtleties in the presentation, method of diagnosis, extent of nodal involvement, and patterns of nodal involvement must be taken into consideration to determine prognosis and optimal therapy. Is the patient with an incidental, pathologically identified, single focus of mediastinal disease the same as the patient with clinically identified multilevel bulky unresectable disease? Clearly not, although both patients share a similar stage, grouping the data presented here clearly demonstrate that these patients differ considerable in their prognosis and in their treatment. The current staging system attempts at assigning a single unifying definition of N2 fails to take into account the numerous subtleties inherent in this patient population. Although it is unlikely that N2 disease will be subclassified to any significant extent, some of these factors may eventually find themselves into a modern revision of our current staging system. For now, the upcoming IASLC revisions to the Union Internationale Contre le Cancer (UICC) staging system will not alter the definitions of nodal disease or add distinct subsets. Therefore, it is imperative that physicians evaluating and treating patients with N2 disease recognize and appreciate the influence of these subtle differences in presentation. Decision making surrounding the treatment of N2-positive patients will continue to remain complex as long as the definition of the disease remains heterogeneous.

Primary esophageal schwannomas are uncommon. We describe a case of a large asymptomatic primary esophageal schwannoma in a 65-year-old patient. Computed tomography and positron emission tomography revealed an (18)F-fluorodeoxyglucose-avid 11-cm mass arising from the esophagus. A preoperative diagnosis was made via endoscopic ultrasound. The patient underwent a three-field esophagogastrectomy with cervical esophagogastric anastomosis. He remains well and free of recurrence 10 months after treatment.