Risk Factors and Effect of Intrathoracic Anastomotic Leakage after Esophagectomy for Underlying Malignancy—A Ten-Year Analysis at a Tertiary University Centre

El-Sourani, Nader; Miftode, Sorin; Alfarawan, Fadl; Troja, Achim; Bockhorn, Maximilian

doi:10.3390/clinpract12050081

Cited by 2 publications

(2 citation statements)

References 22 publications

(24 reference statements)

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“…Peng Su et al 16 One study, including 174 patients with EC, found that the incidence of anastomotic leakage after the operation was 18.96%. 17 These conflicting results may be caused by the geographical differences.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies identified gender, age, body mass index, postoperative complications, etc as the risk factors of anastomotic leakage after MIE. 15,17,18 However, other factors, included in the current study, such as postoperative delirium, adhesion of the thoracic cavity at the operative side, WBC count of the whole blood after the operation and lymphocyte count after the operation, are rarely considered. 19,20 Some patients with postoperative delirium do not cooperate with postoperative recovery, and can be prone to hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

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Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

Su¹,

Huang²,

Lv³

et al. 2023

Pak J Med Sci

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Objective: To explore the risk factors of anastomotic leakage after minimally invasive esophagectomy (MIE) and to build a prediction model of the probability of postoperative anastomotic leakage. Methods: Clinical data of patients undergoing MIE, admitted in the Fourth Hospital of Hebei Medical University from March 2018 to March 2022, were retrospectively selected, and risk factors of anastomotic leakage after MIE were analyzed by univariate and multivariate logistic regression. A prediction nomogram model was established based on the independent risk factors, and its prediction effect was evaluated. Results: A total of 308 patients were included. Thirty patients had postoperative anastomotic leakage, with an incidence of 9.74%. Logistic regression analysis showed that age, postoperative delirium, pleural adhesion, postoperative pulmonary complications, high postoperative white blood cell count and low lymphocyte count were risk factors for postoperative anastomotic leakage. A nomograph prediction model was constructed based on these risk factors. The predicted probability of occurrence of the nomograph model was consistent with the actual probability of occurrence. The calculated C-index value (Bootstrap method) was 0.9609, indicating that the nomograph prediction model had a good discrimination ability. By drawing the receiver operating characteristic (ROC) curve, we showed that the area under the curve (AUC) of the nomograph prediction model was 0.9609 (95%CI: 0.937-0.985), which indicated a good prediction efficiency of the model. Conclusions: The nomograph prediction model based on the independent risk factors of anastomotic leakage after MIE can accurately predict the probability of postoperative anastomotic leakage. doi: https://doi.org/10.12669/pjms.39.5.8050 How to cite this: Su P, Huang C, Lv H, Zhang Z, Tian Z. Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.8050 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

Su¹,

Huang²,

Lv³

et al. 2023

Pak J Med Sci

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Does neoadjuvant therapy contribute to increased risk in anastomotic leakage of esophageal cancer? A network meta‐analysis

Zhou,

Chen,

Song

et al. 2024

J Evidence Based Medicine

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AimConflicting results have been reported about the impact of neoadjuvant therapy on anastomotic leakage (AL) after esophagectomy. We aimed to unravel the potential effect of neoadjuvant therapy on AL after esophagectomy through a network meta‐analysis.MethodsA Bayesian network meta‐analysis was performed by retrieving relevant literature from PubMed, EMbase, The Cochrane Library and Web of Science Core Collection. Randomized clinical trials (RCTs) and retrospective studies (RS) comparing the following treatment modalities were included: neoadjuvant chemoradiation (nCRT), neoadjuvant chemotherapy (nCT), neoadjuvant radiotherapy (nR), neoadjuvant immunochemotherapy (nICT), and surgery alone (SA). Subgroup analyses by radiation dose, examined lymph nodes (ELN), route of reconstruction, site of anastomosis, and surgical approach were also conducted.ResultsA total of 62 studies with 12,746 patients were included for the present study, among which 17 were RCTs. There were no significantly statistical differences observed among the five treatment modalities in AL for both RCTs (nCRT‐nICT: risk ratio 1.51, 95% confidence interval 0.52–4.4; nCT‐nICT: 1.71, 0.56–5.08; nICT‐nR: 0.79, 0.12–8.02; nICT‐SA: 0.59, 0.2–1.84) and RS (nCRT‐nICT: odds ratio 1.53, 95% confidence interval 0.84–2.84; nCT‐nICT: 1.56, 0.87–2.88; nICT‐SA: 0.6, 0.31–1.12; nICT‐nR: 1.08, 0.09–36.02). Subgroup analysis revealed that no significant difference in AL was observed among the five treatment modalities except for the impact of nCRT versus nCT (0.21, 0.05–0.73) on AL with a radiation dose ≥41.4 Gy.ConclusionsNeoadjuvant therapy do not significantly increase the incidence of AL after esophagectomy. Administration of irradiation with a moderate dose is not associated with elevated risk in AL. Clinicians can be less apprehensive about prescribing nCRT.

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Risk Factors and Effect of Intrathoracic Anastomotic Leakage after Esophagectomy for Underlying Malignancy—A Ten-Year Analysis at a Tertiary University Centre

Cited by 2 publications

References 22 publications

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

Does neoadjuvant therapy contribute to increased risk in anastomotic leakage of esophageal cancer? A network meta‐analysis

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