Anastomotic leak predicts diminished long-term survival after resection for gastric and esophageal cancer

Ανδρέου, Ανδρέας; Biebl, Matthias; Dadras, Mehran; Struecker, Benjamin; Sauer, Igor M.; Thuss‐Patience, Peter; Chopra, Sascha; Fikatas, Panagiotis; Bahra, Marcus; Seehofer, Daniel; Pratschke, Johann; Schmidt, Samuel

doi:10.1016/j.surg.2016.02.020

Cited by 72 publications

(67 citation statements)

References 43 publications

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“…Not surprisingly, and consistent with published data, surgical site infection and sepsis are the two most common metrics of NSQIP measured morbidity in this study (16). The organ space SSI of 7.05% is consistent with published rates of anastomotic leaks in recent literature ranging from 5 to 7%, however without targeted NSQIP data collection, the exact proportion of anastomotic leaks rather than other surgically-related causes of intra-abdominal infection cannot be defined precisely (17–20). …”

Section: Discussionsupporting

confidence: 83%

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Martin

Das

Turrentine

et al. 2016

Journal of Gastrointestinal Surgery

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Background Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. Methods This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission and reoperation. Results 3,678 patients underwent gastrectomy. A majority of patients had distal gastrectomy (N= 2,799, 76.1%) and had resection for malignancy (N= 2,316, 63.0%). 798 patients (21.7%) experienced a major complication. Reoperation was required in 290 patients (7.9%). 30-day mortality was 5.2%. Age (OR=1.01, 95% CI: 1.01–1.02, p=0.001), preoperative malnutrition (OR=1.65, 95% CI: 1.35–2.02, p<0.001), total gastrectomy (OR=1.63, 95% CI: 1.31–2.03, p<0.001), benign indication for resection (OR=1.60, 95% CI: 1.29–1.97, p<0.001), blood transfusion (OR=2.57, 95% CI: 2.10–3.13, p<0.001), and intraoperative placement of a feeding tubes (OR=1.28, 95% CI: 1.00–1.62, p=0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR=1.23, 95% CI: 0.99–1.53, p=0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p<0.001). Conclusions Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.

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Section: Discussionsupporting

confidence: 83%

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Martin

Das

Turrentine

et al. 2016

Journal of Gastrointestinal Surgery

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“…There was no disagreement regarding eligibility of full-text articles (Cohen kappa=1). Finally, a total of seven articles fulfilled the selection criteria and were therefore included in this systematic review (21)(22)(23)(24)(25)(26)(27); this pool of articles were retrospective reports. Characteristics of the included studies are presented in Table I, which shows patient information, and in Table II, which demonstrates outcomes of interest.…”

Section: Resultsmentioning

confidence: 99%

Recurrence Following Anastomotic Leakage After Surgery for Carcinoma of the Distal Esophagus and Gastroesophageal Junction: A Systematic Review

et al. 2019

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Background: Esophageal cancer is the ninth most common cancer. The only potentially curative treatment is surgical resection, which unfortunately is still associated with major complications, the most important being anastomotic leakage, currently with an overall rate of up to 26% morbidity. The aim of this systematic review was to evaluate the relationship between anastomotic leakage and recurrence of disease. Materials and Methods: A literature search was systematically performed. Seven out of 312 articles dated between 2009 and 2018 fulfilled the selection for a total of 5,433 patients. Results: The frequency of anastomotic leakage ranged from 7.2 to 11.2%. Patients affected by anastomotic leakage had a recurrence rate of 9-56%. Conclusion: Closer follow-up or even more aggressive oncological therapy should be considered for patients affected by anastomotic leakage after surgery for carcinoma of the distal esophagus and gastroesophageal junction.

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“…[1]. It negatively affects postoperative morbidity and mortality [2], as well as recurrence-free and overall survival [3-5]. Currently, several studies have investigated patient-specific risk factors for the development of AL and described the management of postoperative AL [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

et al. 2017

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Background: Data on the typical time point of occurrence of anastomotic leak (AL) after esophagectomy for esophageal cancer are currently scarce. Therefore, the usefulness of routine radiocontrast agent studies (RRCS) for testing proper healing of the anastomosis after esophagectomy remains unclear. Furthermore, preferred available tools to diagnose postoperative AL and therapeutic options are still under debate. Methods: We present a retrospective analysis of 328 consecutive patients who underwent esophagectomy for esophageal cancer between 2005 and 2015. A RRCS has been performed to date in our center on the fifth postoperative day (POD), before returning to normal oral intake. Results: In total, 49 of 328 patients developed AL after esophagectomy (15%). A total of 11 patients (23%) developed AL before the RRCS and 34 patients (69%) after an unremarkable RRCS; and 4 patients (8%) with AL were diagnosed by RRCS, resulting in overall sensitivity of 16%. The median time point of occurrence of AL was POD 9, the majority of AL (84%) occurred between POD 1 and 19. Computed tomography led to the diagnosis of AL in 41% of patients. The most frequent therapy of AL was stenting in 47% of patients. Endoscopic vacuum therapy was used in 4 patients. Conclusions: The majority of AL occurred within the first 3 weeks after esophagectomy without a typical time point. In our series, RRCS on the fifth POD had a low sensitivity of 16%. Therefore, standardized RRCS and fasting till the examination cannot be generally recommended. In case of clinical suspicion of AL, computed tomography of the chest and abdomen with oral contrast agent should be performed, followed by endoscopy. Endoscopic stent placement remains the standard therapy of AL in our center. Endoscopic vacuum therapy evolves as it is an interesting alternative therapeutic option and can be combined with stenting in selected cases.

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Anastomotic leak predicts diminished long-term survival after resection for gastric and esophageal cancer

Cited by 72 publications

References 43 publications

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Recurrence Following Anastomotic Leakage After Surgery for Carcinoma of the Distal Esophagus and Gastroesophageal Junction: A Systematic Review

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

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