Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy

Abstract

OBJECTIVE:The objective of our study was to identify the incidence and risk factors of anastomotic leaks following transhiatal esophagectomy (THE).MATERIALS AND METHODS:A prospective study was conducted on 61 patients treated for carcinoma of the esophagus between 2006 and 2007. We examined the following variables: age, gender, preoperative cardiovascular function, intraoperative complications such as hypotension, arrhythmia, mediastinal manipulation period, blood loss volume, blood transfusion, duration of surgery, postoperative complications such as anastomotic leak, anastomotic stricture, requiring reoperation, respiratory complications, and total morbidity and mortality. Variables were compared between the patients with and without anastomotic leak. T-test for quantitative variables and Chi-square test for qualitative variables were used to find out any relationship. P value less than 0.05 was considered significant.RESULTS:Out of 61 patients, anastomotic leaks occurred in 13 (21.3%). Weight loss, forced expiratory volume (FEV1) <2 lit, preoperative albumin, intaoperative blood loss volume, and respiratory complication were associated with the anastomotic leak in patients undergoing THE. Anastomotic leaks were the leading cause of postoperative morbidity, anastomotic stricture, and reoperation.CONCLUSION:Anastomotic leakage is a life-threatening postoperative complication. Careful attention to the factors contributing to the development of a leak can reduce the incidence of anastomotic complications postoperatively.

Esophagectomy complications and mortality in esophageal cancer patients, a comparison between trans-thoracic and trans-hiatal methods

“…In our study, intra-operative blood transfusion was associated with post-operative complications. Similarly, multiple investigations showed that intra-operative blood transfusion increased post-operative complications (12,(14)(15)(16)23). Various publications have shown that blood transfusion is a factor that increases mortality (7,8,14,24), whereas our findings indicated that blood transfusion increases complications, but not mortality.…”

“…Anastomosis leakage is considered as one of the most important and serious surgical complications, that can result in mediastinal infection and sepsis. In our study, the rate of anastomosis leakage and fistula was 6.30%, and it ranged between 3%-21.3% in other investigations (4,7,15,16). We found no significant association between anastomosis leakage and mortality, that may be due to anastomosis being located in the neck in most surgeries, which has a lower risk of mediastinitis.…”

Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: Audit from a tertiary care teaching institute

“…The present study identifies the potential non-surgical risk factors associated with anastomotic leakage after major abdominal surgery. Although many studies are available in the literature[ 3 4 5 ] on the role of surgical factors causing anastomotic leakage, very few studies have identified the role of non-surgical factors which are independently associated with increased risk of anastomotic leakage. The most important pathophysiological basis for anastomotic leakage is believed to be ischemia of the gut conduit.…”

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

“…An important factor explaining the wide range of the incidence of AL is the large variety in the definition of this complication throughout the literature [14]. Although the exact etiopathogenesis of AL has not yet been clarified, numerous risk factors for developing this complication have been recognized [15,16,17]. Among others, preoperative weight loss, perioperative blood loss, and longer operative time have been shown to be persistent risk factors across different studies [16,18,19,20].…”