157 SURGICAL PROCEDURE TO REDUCE ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY

• Published in: Diseases of the esophagus Vol. 34; no. Supplement_1
• Main Authors: Okumura, Tomoyuki, Watanabe, Toru, Takeda, Naoya, Mori, Kosuke, Toumatsu, Yuko, Hoshino, Yui, Uotani, Tomohumi, Yamazaki, Takeyosi, Sukegawa, Kenta, Hirano, Katsuhisa, Shibuya, Kazuto, Hojo, Shozo, Matsui, Koushi, Yoshioka, Isaku, Fujii, Tsutomu
• Format: Journal Article
• Language: English
• Published: 17.09.2021
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/doab052.157

Abstract   Anastomotic leakage (AL) is one of the major complications of gastro-esophageal anastomosis after esophagectomy, which causes short-term morbidity and mortality, as well as poor long-term survival. The aim of this study was to investigate factors which were associated with AL after esophagectomy in order to determine the optimal surgical technique to reduce AL. Methods A total of 128 patients with thoracic esophageal cancer underwent subtotal esophagectomy followed by retrosternal reconstruction with gastric conduit with cervical anastomosis using circular staple in our institute from January 2008 and January 2020. The relationship between AL and surgical procedures as well as clinicopathological characteristics of the patients were retrospectively investigated. In addition, we divided the patients into 65 cases in former period (December 2015) and 63 cases in later period (January 2016-) to compare the incidence of AL. Results AL was observed in 12 cases (9.4%) of the 128 patients. The incidence of AL decreased from 16.9% (11/65) in former period to 1.6% (1/63) in later period (p = 0.004). In comparison between the cases with and without AL (12 cases vs 116cases), statistically significant difference was seen in BMI (average ± SD, 24.2 ± 4.7 vs 21.6 ± 3.1; p = 0.02), anastomotic site (posterior wall/greater curvature, 11/1 vs 54/62; p = 0.004), and level of anastomosis (above/below superior border of manubrium of sternum, 12/0 vs 33/83; p < 0.001). While multivariate analysis revealed that former or later period were the only independent factors relevant to AL (p = 0.01). Conclusion Surgical procedure which avoid excessive pressure on the gastric tube from the surrounding structures, such as sternum, may take an important role in reduction of AL after esophagectomy. However, multiple factors, such as nutritional status and obesity, also influence risk of anastomotic leakage.