High cervical anastomosis reduces leakage-related complications after a McKeown esophagectomy

Abstract

OBJECTIVES Anastomotic leak (AL) is one of the most serious complications after oesophageal cancer surgery. High cervical anastomosis using narrow gastric tube based on optimized procedures has the potential to reduce the AL after McKeown oesophagectomy. METHODS A narrow gastric tube was defined as 2–2.5 cm in diameter. Meanwhile, we defined high anastomosis (HA) and normal anastomosis (NA) based on the position of intraoperative cervical anastomosis above or below the level of the inferior thyroid artery, respectively. A total of 533 patients who received McKeown oesophagectomy from March 2018 to March 2023 were included in this study, including 281 patients in the NA group and 252 patients in the HA group. Potential confounding factors in baseline characteristics were balanced by propensity score matching (PSM). RESULTS After matching, 190 patients remained in both groups. In the comparison of pathological and surgical results, we found that the HA group harvested more lymph nodes in both total number (21.1 ± 10.0 vs.15.8 ± 7.7, p = 0.001) and thoracic part (13.5 ± 7.8 vs.10.8 ± 6.1, p = 0.005). The pathological T and TNM stage of patients in the HA group were earlier than those in the NA group (p = 0.001). Overall postoperative complications (p = 0.001), including pulmonary infection (p = 0.001), AL (p < 0.001), leakage related pyothorax (p < 0.001), recurrent laryngeal nerve palsy (p = 0.031), and pleural effusion (p < 0.001), were all significantly lower in the HA group. Finally, multivariable logistic regression analysis indicated that HA was an independent protective factor for AL (OR = 0.331, 95% CI: 0.166–0.658; p = 0.002). CONCLUSIONS For patients undergoing McKeown oesophagectomy, high cervical anastomosis using narrow gastric tube can effectively reduce leakage related complications.