Evaluation of preoperative risk factors and postoperative indicators for anastomotic leak of minimally invasive McKeown esophagectomy: a single-center retrospective analysis

Gao, Chuan; Xú, Gang; Wang, Changyong; Wang, Dong

doi:10.1186/s13019-019-0864-4

Cited by 27 publications

(21 citation statements)

References 27 publications

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“…However, given the operative complexity of esophagectomy and the perioperative resources necessary to care for these patients, this procedure has become increasingly centralized at larger tertiary referral centers, which are more frequently represented in ACS‐NSQIP . Moreover, the rates of anastomotic leak (13.9%) and mortality (2.7%) reported here are similar to prior studies, varying anywhere from 2.96% to 21.9% and 1.0% to 11.6%, respectively . Third, the ACS‐NSQIP does not capture 100% of operative cases performed, which could result in selection bias .…”

Section: Discussionmentioning

confidence: 56%

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

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Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak.Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak.Results: Of 915 patients included, 83% were male and the median age was 64 years.Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak.Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

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Section: Discussionmentioning

confidence: 56%

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

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“…Study characteristics of the included studies are shown in Table 1. The role of systemic biomarkers was evaluated separately in fifteen studies, [32,33,34,35,36,37,38,39,40,41,42,43,44,45,46] drain fluid in nine [33,44,45,46,47,48,49,50,51], combined scoring systems in three studies [35,41,52], and mediastinal microdialysis [53], urine volatile organic compounds [54] and respiratory index [40] were all evaluated in one study. All studies except three [37,53,54] were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…Various definitions of AL were found in the included studies, as shown in Table 2. Six studies [40,42,43,45,49,50] did not mention the median or range concerning the day of AL diagnosis. In the remaining eighteen studies AL was diagnosed with a median on POD 7, ranging between 1 and 30 days.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies [32,33,34,35,36,37,39,40,41,42,43,44,45] evaluated fourteen different inflammatory biomarkers for detecting AL, namely CRP, leucocytes, procalcitonin (PCT), albumin, prealbumin, per centage of neutrophils, fibrinogen levels, urinary volatile organic compounds (VOCs), interleukin (IL) 2R, IL-6, IL-8, IL-10, tumor necrosis factor (TNF) α and blood G antigenemia (BG).…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Mooij

Brink

Merry

et al. 2019

JCM

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Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of investigated biomarkers for the early detection of AL following esophagectomy, esophagogastrectomy and gastrectomy. All published studies evaluating the diagnostic accuracy of biomarkers predicting AL following gastroesophageal resection for cancer were included. The Embase, Medline, Cochrane Library, PubMed and Web of Science databases were searched. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Twenty-four studies evaluated biomarkers in the context of AL following gastroesophageal cancer surgery. Biomarkers were derived from the systemic circulation, mediastinal and peritoneal drains, urine and mediastinal microdialysis. The most commonly evaluated serum biomarkers were C-reactive protein and leucocytes. Both proved to be useful markers for excluding AL owing to its high specificity and negative predictive values. Amylase was the most commonly evaluated peritoneal drain biomarker and significantly elevated levels can predict AL in the early postoperative period. The associated area under the receiver operating characteristic (AUROC) curve values ranged from 0.482 to 0.994. Current biomarkers are poor predictors of AL after gastroesophageal cancer surgery owing to insufficient sensitivity and positive predictive value. Further research is needed to identify better diagnostic tools to predict AL.

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“…A few previous reports have described the relationship between AL and the perioperative nutritional status in patients who received esophagectomy for esophageal cancer. Gao et al have evaluated the risk factors of AL in 96 patients who had been diagnosed with esophageal cancer and underwent resection (20). They found that AL occurred in 12.5% and that a lower prealbumin level was an independent risk factor for AL.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Anastomosis Leak After Esophagectomy for Esophageal Cancer

Aoyama

Atsumi

Hara

et al. 2020

In Vivo

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Background/Aim: The present study aimed to identify risk factors for anastomosis leak (AL) after esophagectomy for esophageal cancer. Patients and Methods: One-hundred twenty-two patients who underwent esophagectomy for esophageal cancer between 2008 and 2018 were included. The rate of AL was measured based on the definition of leak as adapted from the Surgical Infection Study Group. To identify the risk factors for AL, logistic regression analysis was used. Results: AL was found in 44 of the 122 patients (36.1%). Among the factors examined, the lymph node dissection status (p=0.007) and preoperative serum albumin level (p=0.022) were significant independent risk factors for AL. The incidence of AL was 26.7% (20 of 75) among patients who received 2-field lymph node dissection and 51.1% (24 of 47) among those who received 3-field lymph node dissection. The incidence of AL was 29.9% (23 of 77) in the preoperative serum albumin levels ≥4.0 g/dl group and 46.7% (21 of 45) in the serum albumin levels <4.0 g/dl group. Conclusion: Lymph node dissection status and preoperative serum albumin levels were risk factors for AL in patients who received esophagectomy for esophageal cancer. Esophageal cancer is a major cause of cancer death worldwide (1). Complete resection is essential for curing esophageal cancer (2-3). However, the morbidity rate after esophagectomy for esophageal cancer ranges from 30% to 60%, and the morality rate is 1-5% (4-6). Some studies have shown that the development of anastomosis leak (AL) increased the risk of disease recurrence and reduced the overall survival in esophageal cancer patients who received esophagectomy (7-8). Therefore, it is important to predict the occurrence of AL before surgery and determine the most appropriate approach to perioperative care. Recently, the importance of multidisciplinary team efforts, such as oral care and perioperative nutritional care, for preventing AL has been reported (9, 10). However, few studies have investigated the risk factors for AL after esophageal cancer surgery (11-16). Thus, further studies are required to identify these risk factors. If they can be clarified, it will be possible to determine the appropriate indications of oral care and perioperative nutritional care and to select suitable surgical procedures considering the balance between risks and benefits. The aim of the present study was to identify risk factors for AL after esophagectomy for esophageal cancer.

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Evaluation of preoperative risk factors and postoperative indicators for anastomotic leak of minimally invasive McKeown esophagectomy: a single-center retrospective analysis

Cited by 27 publications

References 27 publications

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Risk Factors for Postoperative Anastomosis Leak After Esophagectomy for Esophageal Cancer

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