Objective Anastomotic leakages following oesophagectomy are common postoperative complications associated with increased socioeconomic burden and high mortality rates.Recent studies have confirmed that cervical anastomosis is more frequenyly related with leakages than introthoracic anastomosis.However,cervical anastomotic leakages can be found cervical and intrathoracic manifestation with different clinical outcomes.This study examined management strategies and clinical outcomes of patients who underwent Mckweon esophagectomy and developed leakages in a single high-volume institution in recent years.Methods All esophageal cancer patients undergoing an transthoracic esophagectomy with cervical anastomosis(Mckweon)between January 2015 and December 2018 were included.Patients were identified from a retrospective database.Management strategies and clinical outcomes among patients with cervical anastomotic leakage confined to the neck were compared to patients with intrathoracic manifestation.Results A total of 749 esophagectomies were performed(median age 49(range 38-84)years; mele/female,642/107; Minimally invasive esophagectomy(MIE)/Open,582/167; Neoadjuvant therapy/none,185/564).Leakages of the cervical anastomosis occurred in 53 patients(7.3%,8 patients with tracheal esophageal fistula)at a median diagnosis time of 9 days(4-30 days)after esophagectomy and a median postoperative hospital stay of 51 days(30-163 days).Leakage was confined to the neck in 16 of 53 patients(30.2%),whereas 21 of 53 patients(39.6%)presented with intrathoracic spread.Leakages with intrathoracic manifestation were more frequently accompanied by a positive SIRS score compared to leakages confined to the neck(P<0.001).All patients were initially managed without surgery.Sixteen(30.2%)patients did not have additional management(Type I).Drainage of the anastomotic leakage through the neck wound was effective in all of 16 patients(100%)with cervical manifestation.In patients with intrathoracic manifestation,interventional nasal mediastinal drainage was successful in 19 of 21 patients(90.5%),whereas 1 patient required an intervention through the thoracic cavity and 1 patients with ventilator assisted ventilation.Comared to patients with leakage confined to the neck,patients with intrathoracic manifestation showed prolonged hospital stay,time to oral intake(P<0.001).Finally,46 of 53(86.8%)leakages healed,and 6 patients survive with leakage sinus formation.None of these patients died of leakage(1 died of brain metastasis at day 40 after operation).Conclusions Intrathoracic manifestation of cervical anastomotic leakage occurs in nearly forty percet of patients with anastomotic leakage after Mckweon esophagectomy.Intrathoracic manifestation of leakage results in more frequently SIRS and prolonged hospital stay.Anastomotic leakages can be managed with excellent outcomes with complete drainage through the neck wound or nasal mediastinal drainage without using esophageal stent or surgery.