Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy

Abstract

Objective: Esophagojejunal anastomotic leakages, which occur in the reconstruction procedures performed after total or proximal gastrectomy, still account for one of the most significant causes of morbidity and mortality in spite of the developments seen in perioperative management and surgical techniques in gastric cancer surgery. The aim of the present study was to ascertain the risk factors for Esophagojejunal anastomotic leakages. Material and Methods: A total of 80 patients with gastric cancer, who had total gastrectomy +D2 lymph node dissection and Esophagojejunal anastomotic between January 2013 and December 2016, were retrospectively evaluated. Patients who did not have anastomotic leakages during their clinical follow-ups were allocated to Group 1, whereas those who had anastomotic leakages were allocated to Group 2. Results: A total of 58 (72.5%) out of 80 patients were males, whereas 22 (27.5%) were females. Mean age of the patients was 61.2 ± 11.2 years. There were no demographic differences between the groups. Postoperative recurrent fever (p= 0.001), C-reactive protein values on postoperative days 3 and 5 (p= 0.01), and neutrophil-to-lymphocyte ratio on postoperative day 5 (p= 0.022) were found to be statistically significant with regard to Esophagojejunal anastomotic leakages and other postoperative complications. The duration of operation (p= 0.032) and combined organ resection (p= 0.008) were ascertained as risk factors for Esophagojejunal anastomotic leakages. Conclusion: Surgeons should be careful about Esophagojejunal anastomotic leakages which are significant postoperative complications seen especially in cases where the duration of operation is prolonged, and additional organ resections are performed. Recurrent fever, high C-reactive protein levels, and neutrophil-to-lymphocyte ratio may serve as warnings for complications in postoperative follow-ups.

Risk factors for esophagojejunal anastomotic leakage in curative total gastrectomy combined with D2 lymph node dissection for gastric cancer: A retrospective cohort study

“…One the other hand, the decrease in hemoglobin resulting from extensive blood loss will weaken the oxygen-carrying capacity, thereby causing anastomotic leakage. Three previous studies [1,6,10] reported that longer duration of operation and combined organ resection including splenectomy or pancreatectomy were associated with anastomotic leakage, increasing the risk of morbidity. However, the present study failed to reach this conclusion, and the main reason for this may lie in staff experience and the use of optimized mechanical devices, which make the surgery faster and more secure, ultimately decreasing the incidence of anastomotic leakage.…”

“…Moreover, EJAL has been identi ed as an independent negative prognostic factor for long-term survival [1]. The reported incidence of EJAL varies between 0.5% and 11.5% [1][2][3][4][5][6][7][8][9], and recently, Cetin DA [10] even reported an incidence of up to 16.2%. These data highlight the requirement for the prevention of complications at the perioperative stage.…”

Enhanced Recovery in Surgery for Gastric Cancer

“…Одним из главных условий безопасного применения ПУВ является раннее выявление возможных осложнений и принятие соответствующих мер. Наиболее грозным осложнением в хирургии РЖ является несостоятельность ЭЕА, частота которой, по данным разных авторов, составляет от 1,1 до 16,2 % [47][48][49][50]. В структуре локальных инфекционных осложнений после ГЭ инфильтраты и абсцессы составляют от 1,4 до 5,5 % [5,49].…”

Usefulness of delta neutrophil index as a biomarker to predict postoperative complication in patients who underwent esophagectomy

“…The common biomarkers that predict the occurrence of surgical complications include C-reactive protein (CRP), lactate, leukocytes, percentage of neutrophils, and procalcitonin [4–9] . However, there are only a few studies on the use of biomarkers to predict the complications after esophagectomy, even most of these studies are merely about anastomotic leakage [6–10] …”