Anastomotic leakage after intrathoracic versus cervical oesophagogastric anastomosis for oesophageal carcinoma in Chinese population: a retrospective cohort study

Abstract

ObjectiveTo investigate the characteristics and predictors for anastomotic leakage after oesophagectomy for oesophageal carcinoma from the perspective of anastomotic level.DesignRetrospective cohort study.SettingsA single tertiary medical centre in China.ParticipantsFrom January 2010 to December 2016, all patients with oesophageal cancer of the distal oesophagus or gastro-oesophageal junction undergoing elective oesophagectomy with a curative intent for oesophageal carcinoma with intrathoracic oesophagogastric anastomosis (IOA) versus cervical oesophagogastric anastomosis (COA) were included. We investigated anastomotic level and perioperative confounding factors as potential risk factors for postoperative leakage by univariate and multivariate logistic regression.Primary outcome measuresThe primary outcome was the odds of anastomotic leakage by different confounding factors. Secondary outcome was the association of IOA versus COA with other postoperative outcomes.ResultsOf 458 patients included, 126 underwent cervical anastomosis and 332 underwent intrathoracic anastomosis. Anastomotic leakage developed in 55 patients (12.0%), with no statistical differences between COA and IOA (16.6% vs 10.2%; p=0.058). Multivariable analysis identified active diabetes mellitus (OR 2.001, p=0.047), surgical procedure (open: reference; minimally invasive: OR 1.770, p=0.049) and anastomotic method (semimechanical: reference; stapled: OR 1.821; handsewn: OR 2.271, p=0.048) rather than anastomotic level (IOA: reference; COA: OR 1.622, p=0.110) were independent predictors of leakage.ConclusionsSurgical and anastomotic techniques rather than the level of anastomotic site were independent predictors of postoperative anastomotic leakage in patients undergoing oesophageal cancer surgery.

Risk Factors of Cervical Anastomotic Leakage after McKeown Minimally Invasive Esophagectomy: Focus on Preoperative and Intraoperative Lung Function

“…3) However, this surgical method also had some disadvantages, such as long duration of operation and high incidence of CAL. [2][3][4]6,7) The therapy of CAL included continuous drainage, enhanced nutrition support and anti-infection. Even though the treatment is known, four patients had mediastinal infection and two patients died due to this procedure.…”

“…Furthermore, patients receiving neoadjuvant chemotherapy also demonstrated more postoperative complications and greater impact on cardiopulmonary function, 14,30) which, in turn, reduced tissue perfusion and increased the risk of poor anastomotic healing. More risk factors for CAL after esophagectomy have been identified, which included diabetes mellitus, 2,6,20) BMI, 1) arrhythmia, 2,6,19,21) and smoker at diagnosis. 6) However, these factors were not identified in this study as no uniform conditions were followed.…”

“…2,[10][11][12][13][14][15] CAL after esophagectomy is associated with high postoperative mortality. 2,4) Previous studies have identified various risk factors for CAL, such as neoadjuvant chemotherapy, 4,15,16) chronic obstructive pulmonary disease (COPD), 2) smoker at diagnosis, 6) pneumonia, 17,18) calcification of arteries, 9,19) diabetes mellitus, 2,6,20) body mass index (BMI), 1) and arrhythmia. 2,6,19,21) Some risk factors still remained controversial and so accurate prediction of risk groups for CAL remained very difficult.…”

Pre‐embedded cervical circular stapled anastomosis in esophagectomy

“…However, anastomotic fistula is still the most dangerous complication of mechanical anastomosis, especially in patients undergoing cervical anastomosis . In clinical practice, due to the high position of anastomosis, poor blood supply, high tension and limited operating space, common methods such as embedding and suspension are very difficult to apply in cervical anastomosis …”

“…7 In clinical practice, due to the high position of anastomosis, poor blood supply, high tension and limited operating space, common methods such as embedding and suspension are very difficult to apply in cervical anastomosis. 8,9 We herein introduce an improved embedded cervical esophagogastrostomy method using a circular stapler, and evaluate its efficacy in reducing the incidence of anastomotic fistula, stricture, and reflux.…”