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

Abstract

Background: This study aimed to explore the risk factors associated with esophagojejunal anastomotic leakage (EJAL) in curative total gastrectomy combined with D2 lymph node dissection for gastric cancer.Methods: 390 consecutive patients receiving Roux-en-Y esophagojejunostomy reconstruction after surgery were reviewed. Multivariate analysis was performed using a logistic regression model to identify independent risk factors for EJAL.Results: Of the 390 patients enrolled in this study, EJAL occurred in 10 patients (2.6%). One patient (1/10) with EJAL died. Univariate analysis identified age (P = 0.025), alcohol consumption (P = 0.019), pulmonary insufficiency (P = 0.049), and intraoperative blood loss (P = 0.015) as risk factors for EJAL. Of these four risk factors, age (P = 0.043) and alcohol consumption (P = 0.043) were retained as independent risk factors by multivariate analysis.Conclusions: Surgeons should be very careful about anastomotic leakage during the perioperative period, especially in patients with advanced age and a history of alcohol consumption. Pulmonary insufficiency and intraoperative blood loss, although not being identified as independent risk factors, should also be considered.

Predictive Factors for Anastomotic Leakage after Laparoscopic and Open Total Gastrectomy: A Systematic Review

“…Two studies reported that age is an independent risk factor of EJAL in multivariate analysis [ 12 , 13 ]. Xing et al [ 12 ] collected 390 patients and demonstrated that an age greater than 65 is closely related to the risk of developing anastomotic leakage (P: 0.043; OR: 3.882; 95% CI: 1.045–14.422).…”

“…Two studies reported that age is an independent risk factor of EJAL in multivariate analysis [ 12 , 13 ]. Xing et al [ 12 ] collected 390 patients and demonstrated that an age greater than 65 is closely related to the risk of developing anastomotic leakage (P: 0.043; OR: 3.882; 95% CI: 1.045–14.422). Kanaji et al [ 13 ], in their prospective study with 185 patients, set 75 years old as the threshold to make the variable significant on anastomosis leak risk (P: 0.0097; OR: 7349; 95% CI: 1.63–39.475).…”

Machine Learning-based Correlation Study between Perioperative Immunonutritional Index and Postoperative Anastomotic Leakage in Patients with Gastric Cancer

“…Over the years, there were constant discussions on theories for factors of postoperative AL. Some of the factors were accepted by most researchers, including malnutrition, hyper-tensility on the anastomotic stoma, lack of blood supply or local inflammation around anastomotic regions 8 , 11 , 23 . Other possible factors include advanced ages, high BMI, medical history of neoadjuvant chemotherapy, low hemoglobin 7 , 22 .…”

“…However, postoperative anastomotic leakage remains to be clinically concerning with an incidence of 2.1-14.6% and a mortality rate of up to 50% reportedly, which could cause prolonged hospital stay, increased overall cost, and even compromised long-term survival [4][5][6][7]. Present methods for detecting postoperative AL mostly depend on laboratory examination and radiological diagnosis [8] . However, in case of severe complications like AL, advanced medical treatment before clinically confirmed could seize the opportunity and greatly enhance curative effect [9,10] .…”

The Contribution of a Collagen Patch Coated With Fibrin Glue in Sealing Upper Gastrointestinal Defects: An Experimental Study

“…Several clinical and experimental studies have been conducted to increase the safety of anastomoses and primary repaired injuries (gastric or duodenal perforation), thereby decreasing the incidence of these complications (5,6). Through several trials, a variety of materials have been evaluated to decrease the incidence of leakage and any related consequences (7)(8)(9).…”