Risk stratification of anastomotic leakage using eGFR and FIB-4 index in patients undergoing esophageal cancer surgery

• Published in: Langenbeck's archives of surgery Vol. 406; no. 6; pp. 1867 - 1874
• Main Authors: Takahashi, Keita, Nishikawa, Katsunori, Tanishima, Yuichiro, Ishikawa, Yoshitaka, Masuda, Takahiro, Kurogochi, Takanori, Yuda, Masami, Tanaka, Yujiro, Matsumoto, Akira, Yano, Fumiaki, Eto, Ken
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2021
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Esophagectomy; Anastomotic leakage; FIB-4 index; Estimated glomerular filtration rate; Esophageal cancer
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-021-02272-z

Purpose Renal insufficiency and liver cirrhosis are identified as independent risk factors for anastomotic leakage (AL) after esophagectomy. However, research evaluating the incidence of AL using quantitative data to measure renal function and liver fibrosis remain to be limited. Therefore, this study was conducted to evaluate postoperative AL after esophagectomy using estimated glomerular filtration rate (eGFR) and fibrosis-4 (FIB-4) index. Methods In total, 184 patients who underwent esophagectomy were included in this study; then, they were divided into the non-AL group ( n  = 161) and AL group ( n  = 23), after which their background data and intraoperative and postoperative outcomes were compared. In addition, risk factors for AL were evaluated using a logistic regression model. Results Preoperative body mass index of ≥21.5 kg/m 2 , hemoglobin A1c level of ≥7.3%, FIB-4 index of ≥1.44, and eGFR of <59 ml/min/1.73 m 2 were found to be significantly frequent in the AL group compared with the non-AL group. Multivariate analysis revealed FIB-4 index of ≥1.44 ( p  = 0.013; OR, 3.780; 95% CI, 1.320–10.800) and eGFR of <59 ml/min/1.73 m 2 ( p  = 0.018; OR, 3.110; 95% CI, 1.220–8.020) as the independent risk factors for AL. In addition, we stratified the patients into three groups based on the incidence of AL as follows: low risk (5.5%, low FIB-4 index), intermediate risk (13.0%, high FIB-4 index and eGFR), and high risk (37.5%, high FIB-4 index and low eGFR). Conclusion Preoperative eGFR and FIB-4 index were found to be useful markers to predict AL after esophagectomy.