Prevalence and outcome of esophagogastric anastomotic leak after esophagectomy in a UK regional cancer network

Abstract

The aim of this study was to determine the contemporary prevalence, outcome, and survival after esophagogastric anastomotic leakage (EGAL) following esophagectomy by a regional upper gastrointestinal cancer network and to investigate etiological factors. Two hundred forty consecutive patients underwent esophagectomy over a 10-year period (median age 61 [31-79] years, 147 transthoracic and 93 transhiatal esophagectomy, 105 neoadjuvant chemotherapy, 49 chemoradiotherapy). The primary outcome measures were the development of EGAL and survival. Twenty patients developed EGAL (8.3%, 15 managed conservatively, 5 reoperation). Overall operative mortality was 2% (5 patients in total, 1 after EGAL). Median, 1 and 2-year survival was 22 months, 73% and 50%, in patients after EGAL, compared with 31 months, 80% and 56%, in patients who did not suffer EGAL (P= 0.314). On multivariate analysis, low body mass indices (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11-0.79, P= 0.016), individual surgeon (HR 1.21, 95% CI 1.02-1.43, P= 0.02), and neoadjuvant chemotherapy (HR 3.28, 95% CI 1.16-9.22, P= 0.024) were significantly associated with the development of EGAL. EGAL following esophagectomy remained common, but associated mortality was less common than reported in earlier Western series and long-term survival was unaffected.

Predictors and outcome of cervical anastomotic leakage after esophageal cancer surgery

“…However, it is reported that creatinine level, in terms of renal insufficiency, is not an independent risk factor, but in aggregate with other comorbid diseases it can be predictive of leakage. [9,12,13,21] Although preoperative nutritional state and weight loss of patients are possible determining factors of postoperative complications; [9,12,13,21] we could not identify any correlation between hypoalbuminemia and leakage. This finding is in agreement with some other studies.…”

“…[9,12,13,21] In the present study, patients with the history of hypertension, diabetes mellitus, higher levels of creatinine, and lower FEV1% were predisposed to developing anastomotic leakage. These results are consistent with those of other studies that suggest higher numbers of preoperative medical comorbidities including renal insufficiency, heart disease, diabetes, hypertension, previous stroke and chronic obstructive pulmonary disease are risk factors for developing anastomotic leakage.…”

“…This finding is in agreement with some other studies. [9,12,13,21] Location and histology of the tumor, and TNM staging were not significantly associated with leakage. However, tumors that were poorly differentiated tended to leak more.…”

“…[11] Multiple perioperative factors reported to be associated with anastomotic leakage include age, gender, preoperative weight loss, blood levels of hemoglobin and albumin, histological cell type of tumor, stage of the tumor, location of tumor, the organ used for esophagus substitute, the technique and location of anastomosis (cervical or intrathoracic), whether it is a single or double layer, or done manually or with stapling, the distance between the anastomosis line and the tumoral tissue, microscopic involvement of surgical resection margins, neoadjuvant therapy, and additional radiotherapy or chemotherapy. [2,9,[12][13][14][15][16][17][18] The aim of this study is to identify the predictive factors for anastomotic leak and its consequences in patients with esophageal cancer after esophagectomy at a high volume cancer institute.…”

Intrathoracic anastomotic leakage after gastroesophageal cancer resection is associated with increased risk of recurrence

“…1,2 One of the most feared surgical complications is anastomotic leakage, which occurs in up to 10% of these patients. [3][4][5][6][7][8][9] Anastomotic leakage exerts an obvious negative influence by increasing the risk of immediate morbidity and mortality, but many believe that leakage additionally increases the risk of recurrence. 10 These studies demonstrated a trend, but they failed to show a clear and significant negative effect on long-term survival, presumably because of the small patient cohorts and the inconsistent definitions of leakage.…”