Top

World Journal of Surgery

Published in:

01-05-2016 | Original Scientific Report

Factors Affecting Hospital Mortality in Patients with Esophagogastric Anastomotic Leak: A Retrospective Study

Authors: Bin Li, Jiaqing Xiang, Yawei Zhang, Hong Hu, Yihua Sun, Haiquan Chen

Published in: World Journal of Surgery | Issue 5/2016

Abstract

Objective

We aimed to clarify the association between anastomotic leak and leak-associated mortality to assist decision-making and reduce hospital mortality.

Background

Anastomotic leak is a common complication after esophagectomy, but the nature of its relationship to leak-associated mortality has not been established.

Methods

A retrospective review of all esophagogastric anastomotic leaks that had occurred between 2008 and 2012 at our institution (n = 246) was performed. Risk factors for leak-associated mortality were determined using a multivariate logistic regression analysis.

Results

Of the 246 patients with anastomotic leaks, 14 (5.7 %) died. Leak-associated mortality rates were similar regardless of anastomosis location (cervical vs. thoracic anastomosis), surgical approaches (retrosternal vs. prevertebral reconstruction route) and anastomotic techniques (hand-sewn vs. mechanical anastomosis). When a leak occurred, risk factors for leak-associated mortality as determined by multivariate logistic analysis included patient age >60 years (P = 0.029) and the occurrence of the leak within 1 week of surgery (P = 0.039). When disease worsened after treatment, leak-associated mortality was more frequent in patients requiring reintubation (25.6 vs. 1.4 %, P < 0.001). Fatal bleeding and sepsis were the most common causes of leak-associated mortality.

Conclusion

In patients with anastomotic leaks, patient age >60 years and the occurrence of the leak within 1 week of surgery were risk factors for leak-associated mortality. Increased efforts to reduce the incidence of early anastomotic leaks within 1 week after surgery and prevent the need for reintubation are important for improving patient prognosis.

Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669CrossRefPubMed

Liu JF, Wang QZ, Ping YM et al (2008) Complications after esophagectomy for cancer: 53-year experience with 20,796 patients. World J Surg 32:395–400. doi:10.1007/s00268-007-9349-z CrossRefPubMed

Markar SR, Karthikesalingam A, Penna M et al (2014) Assessment of short-term clinical outcomes following salvage esophagectomy for the treatment of esophageal malignancy: systematic review and pooled analysis. Ann Surg Oncol 21:922–931CrossRefPubMed

Biere SS, Maas KW, Cuesta MA et al (2011) Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg 28:29–35CrossRefPubMed

Kassis ES, Kosinski AS, Ross P Jr et al (2013) Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg 96:1919–1926CrossRefPubMed

Rutegård M, Lagergren P, Rouvelas I et al (2012) Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol 19(1):99–103CrossRefPubMed

Crestanello JA, Deschamps C, Cassivi SD et al (2005) Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg 129(2):254–260CrossRefPubMed

Cooke DT, Lin GC, Lau CL et al (2009) Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection. Ann Thorac Surg 88(1):177–184CrossRefPubMed

Markar SR, Arya S, Karthikesalingam A et al (2013) Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol 20(13):4274–4281CrossRefPubMed

10.

Lerut T, Coosemans W, Decker G et al (2002) Anastomotic complications after esophagectomy. Dig Surg. 19(2):92–98CrossRefPubMed

11.

Low DE, Alderson D, Cecconello I et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg

12.

Li B, Chen H, Xiang J et al (2012) Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: a single-institution experience. J Thorac Cardiovasc Surg 144:778–785CrossRefPubMed

13.

Schaheen L, Blackmon SH, Nason KS (2014) Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg 208(4):536–543CrossRefPubMedPubMedCentral

14.

Turkyilmaz A, Eroglu A, Aydin Y et al (2009) The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus 22(2):119–126CrossRefPubMed

15.

Sauvanet A, Mariette C, Thomas P, Lozac’h P, Segol P, Tiret E, Delpero JR, Collet D, Leborgne J, Pradère B, Bourgeon A, Triboulet JP et al (2005) Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg. 201(2):253–262CrossRefPubMed

16.

Junemann-Ramirez M, Awan MY, Khan ZM et al (2005) Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on long term survival in a high volume centre. Eur J Cardiothorac Surg 27(1):3–7CrossRefPubMed

17.

Alanezi K, Urschel JD (2004) Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 10(2):71–75PubMed

18.

Tandon S, Batchelor A, Bullock R et al (2001) Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth 86(5):633–638CrossRefPubMed

19.

Morita M, Yoshida R, Ikeda K et al (2008) Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid. Dis Esophagus 21(1):30–36PubMed

20.

Martin LW, Swisher SG, Hofstetter W et al (2005) Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg 242(3):392–399PubMedPubMedCentral

21.

Schweigert M, Solymosi N, Dubecz A et al (2013) Endoscopic stent insertion for anastomotic leakage following oesophagectomy. Ann R Coll Surg Engl 95(1):43–47CrossRefPubMedPubMedCentral

22.

Nguyen NT, Rudersdorf PD, Smith BR et al (2011) Management of gastrointestinal leaks after minimally invasive esophagectomy: conventional treatments vs. endoscopic stenting. J Gastrointest Surg. 15(11):1952–1960CrossRefPubMed

Title: Factors Affecting Hospital Mortality in Patients with Esophagogastric Anastomotic Leak: A Retrospective Study
Authors: Bin Li
Jiaqing Xiang
Yawei Zhang
Hong Hu
Yihua Sun
Haiquan Chen
Publication date: 01-05-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 5/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3372-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors Affecting Hospital Mortality in Patients with Esophagogastric Anastomotic Leak: A Retrospective Study

Abstract

Objective

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2016

Surgical Apgar Score Predicted Postoperative Morbidity After Esophagectomy for Esophageal Cancer

Efficacy and Toxicity of Hepatic Intra-Arterial Drug-Eluting (Irinotecan) Bead (DEBIRI) Therapy in Irinotecan-Refractory Unresectable Colorectal Liver Metastases

In-Hospital Mortality in a 4-Year Cohort Study of 3,093,254 Operations in Seniors

Retrospective Analyses of Esophageal Bypass Surgery for Patients with Esophagorespiratory Fistulas Caused by Esophageal Carcinomas

Anesthesia Care Capacity at Health Facilities in 22 Low- and Middle-Income Countries

Post-Hospital Discharge Venous Thromboembolism in Colorectal Surgery