Long-term outcomes of the application of fibrin sealant in the prevention of cervical anastomotic leakage after McKeown esophagectomy

Abstract

Background Anastomotic leakage remains an issue after esophagectomy. Previous studies have indicated that the intraoperative application of fibrin sealant could reduce the incidence of anastomotic leakage. This study reported survival outcomes among EC or EJC patients who received the intraoperative application of fibrin sealant during McKeown esophagectomy. Methods We designed a retrospective study including 227 patients with esophageal or esophagogastric junction cancer undergoing McKeown esophagectomy performed by our team between January 2018 and December 2019, of whom 86 patients were included in the FS group and 141 patients were included in the control group. Intraoperatively, 2.5 ml of porcine fibrin sealant was applied circumferentially to the cervical anastomosis in the FS group. The primary outcome was the impact of applying fibrin sealant to cervical anastomosis on the survival of patients after surgery. Results The median follow-up was 41 months (range, 0–52). The three-year overall survival (FS group vs. control group: 75.6% vs. 74,4%, p = 0.96) and the three-year disease-free survival (82% vs. 74,4%, p = 0.116) were not significantly different between the two groups. In the long-term follow-up, the total rates of AL between the two groups were 4.7% vs. 19.9% (p = 0.003), while the total rates of anastomotic stricture were 2.3% vs. 7.1% (p = 0.139). Cervical local recurrence was 4.7% versus 2.1% (p = 0.431). Cox regression analyses showed that the application of FS was not a predictor for overall survival. Conclusions The intraoperative application of fibrin sealant could prevent cervical anastomotic leakage after McKeown esophagectomy but did not improve survival outcomes. Further prospective clinical trials are warranted.