Analysis of risk factors of cervical anastomotic leakage after esophageal cancer operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Weiguo , LI Mian , SHAN Yange , QIAO Bin , LEI Caipeng , FAN Junli , CHEN Qiang , LIU Qin

Henan Key Laboratory of Cancer Epigenetics, Cancer Institute, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, Henan, P.R.China;

Corresponding author：

ZHANG Weiguo, Email: paulzhang630@sina.com.cn

Keywords：

Esophageal cancer; anastomotic leakage; risk factors

DOI：

10.7507/1007-4848.201908072

Video：

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Objective To analyze the risk factors of anastomotic leakage after esophagectomy.Methods The clinical data of 1 328 patients with esophageal cancer, who underwent esophagectomy in the First Affiliated Hospital of Henan University of Science and Technology from January 2010 to December 2016, were retrospectively analyzed. There were 726 males and 602 females, at an average age of 67.2±14.1 years. According to whether there was anastomotic leakage after operation, patients were divided into two groups: an anastomotic leakage group (167 patients) and a non-anastomotic leakage group (1 161 patients). Univariate and multivariate logistic regression analysis was used to identify related risk factors of anastomotic leakage after operation.Results The incidence of postoperative anastomotic leakage was 12.6% (167/1 328). Univariate analysis showed that body mass index, arrhythmia, chronic obstructive pulmonary disease (COPD), diabetes, preoperative albumin level, preoperative chemotherapy and chemoradiotherapy, lesion location, anastomosis types and postoperative pulmonary infection were associated with statistically significant increase in risk of cervical anastomotic leakage (P<0.05). Logistic regression analysis showed that preoperative COPD, lesion location and postoperative pulmonary infection were independent risk factors of cervical anastomotic leakage after esophagectomy (P<0.05).Conclusion The occurrence of cervical anastomotic leakage after esophageal cancer is related to many factors. The preoperative COPD, the lesion location and the postoperative pulmonary infection are independent high risk factors. Paying attention to these factors and doing perioperative management can effectively reduce the occurrence of anastomotic leakage.

Citation： ZHANG Weiguo, LI Mian, SHAN Yange, QIAO Bin, LEI Caipeng, FAN Junli, CHEN Qiang, LIU Qin. Analysis of risk factors of cervical anastomotic leakage after esophageal cancer operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(3): 303-307. doi: 10.7507/1007-4848.201908072 Copy

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2.	陈传贵, 于振涛, 金庆文, 等. 食管癌术后吻合口瘘的临床特点及危险因素分析. 中华外科杂志, 2015, 53(7): 518-521.
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4.	Klevebro F, Elliott JA, Slaman A, et al. Cardiorespiratory comorbidity and postoperative complications following esophagectomy: a European multicenter cohort study. Ann Surg Oncol, 2019, 26(9): 2864-2873.
5.	Klevebro F, Johnsen G, Johnson E, et al. Morbidity and mortality after surgery for cancer of the oesophagus and gastro-oesophageal junction: A randomized clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiation. Eur J Surg Oncol, 2015, 41(7): 920-926.
6.	Kassis ES, Kosinski AS, Ross P Jr, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
7.	van Rossum PSN, Haverkamp L, Carvello M, et al. Management and outcome of cervical versus intrathoracic manifestation of cervical anastomotic leakage after transthoracic esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-8.
8.	Ma H, Wang J, Xi Q, et al. Analysis of endoscopy intervention in postesophagectomy anastomotic leak: A retrospective study. Thorac Cardiovasc Surg, 2019, 67(7): 597-602.
9.	Markar SR, Arya S, Karthikesalingam A, et al. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(13): 4274-4281.
10.	Sun HB, Li Y, Liu XB, et al. Embedded three-layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer. Ann Thorac Surg, 2016, 101(3): 1131-1138.
11.	Markar SR, Bodnar A, Rosales J, et al. The impact of neoadjuvant chemoradiotherapy on perioperative outcomes, tumor pathology, and survival in clinical stage Ⅱ and Ⅲ esophageal cancer. Ann Surg Oncol, 2013, 20(12): 3935-3941.
12.	Merritt RE, Whyte RI, D'Arcy NT, et al. Morbidity and mortality after esophagectomy following neoadjuvant chemoradiation. Ann Thorac Surg, 2011, 92(6): 2034-2040.
13.	Zhan M, Zheng H, Yang Y, et al. Cost-effectiveness analysis of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced esophageal squamous cell carcinoma based on the NEOCRTEC5010 trial. Radiother Oncol, 2019, 142: 27-32.
14.	Gronnier C, Tréchot B, Duhamel A, et al. Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study. Ann Surg, 2014, 260(5): 764-770.
15.	Ma HF, Lv GX, Cai ZF, et al. Comparison of the prognosis of neoadjuvant chemoradiotherapy treatment with surgery alone in esophageal carcinoma: a meta-analysis. Onco Targets Ther, 2018, 11: 3441-3447.
16.	Rajabi Mashhadi M, Bagheri R, Abdollahi A, et al. The effect of neoadjuvant therapy on early complications of esophageal cancer surgery. Iran J Otorhinolaryngol, 2015, 27(81): 279-284.
17.	Tessier W, Gronnier C, Messager M, et al. Does timing of surgical procedure after neoadjuvant chemoradiation affect outcomes in esophageal cancer? Ann Thorac Surg, 2014, 97(4): 1181-1189.
18.	张晗, 张耀超, 柳立军, 等. 颈段食管压力差与颈部吻合口瘘形成的关系. 中国胸心血管外科临床杂志, 2017, 24(8): 64-68.
19.	Campbell C, Reames MK, Robinson M, et al. Conduit vascular evaluation is associated with reduction in anastomotic leak after esophagectomy. J Gastrointest Surg, 2015, 19(5): 806-812.
20.	Biere SS, Maas KW, Cuesta MA, et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg, 2011, 28(1): 29-35.
21.	Schlottmann F, Patti MG. Prevention of postoperative pulmonary complications after esophageal cancer surgery. J Thorac Dis, 2019, 11(Suppl 9): S1143-S1144.

1. 田烨, 周凌霄, 任光国. 1208 例食管癌患者术后吻合口瘘风险因素分析. 重庆医学, 2014, 43(15): 1924-1927.
2. 陈传贵, 于振涛, 金庆文, 等. 食管癌术后吻合口瘘的临床特点及危险因素分析. 中华外科杂志, 2015, 53(7): 518-521.
3. Thrift AP. The epidemic of oesophageal carcinoma: Where are we now? Cancer Epidemiol, 2016, 41: 88-95.
4. Klevebro F, Elliott JA, Slaman A, et al. Cardiorespiratory comorbidity and postoperative complications following esophagectomy: a European multicenter cohort study. Ann Surg Oncol, 2019, 26(9): 2864-2873.
5. Klevebro F, Johnsen G, Johnson E, et al. Morbidity and mortality after surgery for cancer of the oesophagus and gastro-oesophageal junction: A randomized clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiation. Eur J Surg Oncol, 2015, 41(7): 920-926.
6. Kassis ES, Kosinski AS, Ross P Jr, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
7. van Rossum PSN, Haverkamp L, Carvello M, et al. Management and outcome of cervical versus intrathoracic manifestation of cervical anastomotic leakage after transthoracic esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-8.
8. Ma H, Wang J, Xi Q, et al. Analysis of endoscopy intervention in postesophagectomy anastomotic leak: A retrospective study. Thorac Cardiovasc Surg, 2019, 67(7): 597-602.
9. Markar SR, Arya S, Karthikesalingam A, et al. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(13): 4274-4281.
10. Sun HB, Li Y, Liu XB, et al. Embedded three-layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer. Ann Thorac Surg, 2016, 101(3): 1131-1138.
11. Markar SR, Bodnar A, Rosales J, et al. The impact of neoadjuvant chemoradiotherapy on perioperative outcomes, tumor pathology, and survival in clinical stage Ⅱ and Ⅲ esophageal cancer. Ann Surg Oncol, 2013, 20(12): 3935-3941.
12. Merritt RE, Whyte RI, D'Arcy NT, et al. Morbidity and mortality after esophagectomy following neoadjuvant chemoradiation. Ann Thorac Surg, 2011, 92(6): 2034-2040.
13. Zhan M, Zheng H, Yang Y, et al. Cost-effectiveness analysis of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced esophageal squamous cell carcinoma based on the NEOCRTEC5010 trial. Radiother Oncol, 2019, 142: 27-32.
14. Gronnier C, Tréchot B, Duhamel A, et al. Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study. Ann Surg, 2014, 260(5): 764-770.
15. Ma HF, Lv GX, Cai ZF, et al. Comparison of the prognosis of neoadjuvant chemoradiotherapy treatment with surgery alone in esophageal carcinoma: a meta-analysis. Onco Targets Ther, 2018, 11: 3441-3447.
16. Rajabi Mashhadi M, Bagheri R, Abdollahi A, et al. The effect of neoadjuvant therapy on early complications of esophageal cancer surgery. Iran J Otorhinolaryngol, 2015, 27(81): 279-284.
17. Tessier W, Gronnier C, Messager M, et al. Does timing of surgical procedure after neoadjuvant chemoradiation affect outcomes in esophageal cancer? Ann Thorac Surg, 2014, 97(4): 1181-1189.
18. 张晗, 张耀超, 柳立军, 等. 颈段食管压力差与颈部吻合口瘘形成的关系. 中国胸心血管外科临床杂志, 2017, 24(8): 64-68.
19. Campbell C, Reames MK, Robinson M, et al. Conduit vascular evaluation is associated with reduction in anastomotic leak after esophagectomy. J Gastrointest Surg, 2015, 19(5): 806-812.
20. Biere SS, Maas KW, Cuesta MA, et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg, 2011, 28(1): 29-35.
21. Schlottmann F, Patti MG. Prevention of postoperative pulmonary complications after esophageal cancer surgery. J Thorac Dis, 2019, 11(Suppl 9): S1143-S1144.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of risk factors of cervical anastomotic leakage after esophageal cancer operation

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