Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Abstract

Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak.Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak.Results: Of 915 patients included, 83% were male and the median age was 64 years.Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak.Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

The Variation Tendency of Serum C-Reactive Protein is A Good Marker to Exclude Anastomotic Leakage after Laparoscopic Gastrectomy for Adenocarcinoma of Esophagogastric Junction

“…The multivariate analysis suggested that operation time longer than 360 minutes signi cantly increased the risk of major PCs (OR 6.753, 95% CI 2.037-22.395, p = 0.002). This nding was consistent with other studies [27][28][29]. Secondly, the pathologic stage of patients enrolled in this study were much later.…”

The variation tendency of serum C-reactive protein is a good marker to predict postoperative complications after laparoscopic gastrectomy for adenocarcinoma of esophagogastric junction

“…Univariate and multivariate analyses of clinical factors for major postoperative complicationsThe multivariate analysis suggested that operation time longer than 360 minutes signi cantly increased the risk of major PCs (OR 6.753, 95% CI 2.037-22.395, p=0.002). This nding was consistent with other studies[23][24][25]. Furthermore, our research revealed that proximal gastrectomy with double-tract anastomosis increased the risk of major PCs (OR 8.224, 95% CI 1.976-34.234, p=0.004).…”

Risk Factors for Severe Complications After Laparoscopic Surgery for T3 or T4 Rectal Cancer for Chinese Patients: Experience from a Single Center

“…Moyes et al reported that elevated preoperative white cell count ( P <0.05) were independently associated with increased risk of developing a postoperative infection [ 31 ]. Another recent study showed that increased preoperative WBC count was independently associated with anastomotic leak after esophagectomy [ 32 ]. In aforementioned analysis, the authors estimate that for every 3000/μL increase in the preoperative WBC count, the associated risk increased by 32% [ 32 ].…”

“…Another recent study showed that increased preoperative WBC count was independently associated with anastomotic leak after esophagectomy [ 32 ]. In aforementioned analysis, the authors estimate that for every 3000/μL increase in the preoperative WBC count, the associated risk increased by 32% [ 32 ].…”