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Published in: Annals of Surgical Oncology 1/2012

01-01-2012 | Thoracic Oncology

Intrathoracic Anastomotic Leakage and Mortality After Esophageal Cancer Resection: A Population-Based Study

Authors: Martin Rutegård, MD, PhD, Pernilla Lagergren, RN, PhD, Ioannis Rouvelas, MD, PhD, Jesper Lagergren, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2012

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Abstract

Background

Results are conflicting and no population-based studies are available regarding the postoperative mortality after intrathoracic anastomotic leakage. The current study addressed the unselected and independent fatality rate of intrathoracic esophageal anastomotic leaks after resection for cancer.

Methods

A prospective, nationwide study was conducted in Sweden in April 2001 through December 2005. Details concerning patient and tumor characteristics, surgical procedures, postoperative anastomotic leakage, and mortality were collected prospectively. Logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for age, tumor stage, comorbidity, and hospital volume.

Results

Among 559 resected patients with an intrathoracic anastomosis, 44 patients (7.9%) sustained an anastomotic leak within 30 days of surgery. Of these, 8 patients (18.2%) died within 90 days of surgery, compared with 32 of the 515 patients without leakage (6.2%) (P = .003). The adjusted OR of postoperative death following intrathoracic anastomotic leakage was increased 3-fold compared with those without such a complication (OR 3.0, 95% CI 1.2–7.2).

Conclusion

Intrathoracic anastomotic leakage after esophageal resection for cancer remains a major risk factor for short-term postoperative death in an unselected, population-based setting.
Literature
1.
go back to reference Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol. 2003;4:481–8.PubMedCrossRef Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol. 2003;4:481–8.PubMedCrossRef
2.
go back to reference Lerut T, Coosemans W, Decker G, De Leyn P, Moons J, Nafteux P, et al. Surgical techniques. J Surg Oncol. 2005;92:218–29.PubMedCrossRef Lerut T, Coosemans W, Decker G, De Leyn P, Moons J, Nafteux P, et al. Surgical techniques. J Surg Oncol. 2005;92:218–29.PubMedCrossRef
3.
go back to reference Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg. 2004;10:71–5.PubMed Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg. 2004;10:71–5.PubMed
4.
go back to reference Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg. 2005;27:3–7.PubMedCrossRef Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg. 2005;27:3–7.PubMedCrossRef
5.
go back to reference Sauvanet A, Mariette C, Thomas P, Lozac’h P, Segol P, Tiret E, et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg. 2005;201:253–62.PubMedCrossRef Sauvanet A, Mariette C, Thomas P, Lozac’h P, Segol P, Tiret E, et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg. 2005;201:253–62.PubMedCrossRef
6.
go back to reference Griffin SM, Shaw IH, Dresner SM. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management. J Am Coll Surg. 2002;194:285–97.PubMedCrossRef Griffin SM, Shaw IH, Dresner SM. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management. J Am Coll Surg. 2002;194:285–97.PubMedCrossRef
7.
go back to reference Martin LW, Swisher SG, Hofstetter W, Correa AM, Mehran RJ, Rice DC, et al. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg. 2005;242:392–9; discussion 399–402.PubMed Martin LW, Swisher SG, Hofstetter W, Correa AM, Mehran RJ, Rice DC, et al. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg. 2005;242:392–9; discussion 399–402.PubMed
8.
go back to reference Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004;78:1170–6.PubMedCrossRef Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004;78:1170–6.PubMedCrossRef
9.
go back to reference Rutegard M, Lagergren J, Rouvelas I, Lagergren P. Surgeon volume is a poor proxy for skill in esophageal cancer surgery. Ann Surg. 2009;249:256–61.PubMedCrossRef Rutegard M, Lagergren J, Rouvelas I, Lagergren P. Surgeon volume is a poor proxy for skill in esophageal cancer surgery. Ann Surg. 2009;249:256–61.PubMedCrossRef
10.
go back to reference Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85:1457–9.PubMedCrossRef Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85:1457–9.PubMedCrossRef
11.
12.
go back to reference Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRef Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRef
13.
go back to reference Ferri LE, Law S, Wong KH, Kwok KF, Wong J. The influence of technical complications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol. 2006;13:557–64.PubMedCrossRef Ferri LE, Law S, Wong KH, Kwok KF, Wong J. The influence of technical complications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol. 2006;13:557–64.PubMedCrossRef
14.
go back to reference Rouvelas I, Lindblad M, Zeng W, Viklund P, Ye W, Lagergren J. Impact of hospital volume on long-term survival after esophageal cancer surgery. Arch Surg. 2007;142:113–7; discussion 118.PubMedCrossRef Rouvelas I, Lindblad M, Zeng W, Viklund P, Ye W, Lagergren J. Impact of hospital volume on long-term survival after esophageal cancer surgery. Arch Surg. 2007;142:113–7; discussion 118.PubMedCrossRef
15.
go back to reference National Board of Health and Welfare. Cancer Incidence in Sweden 2008. 2009. National Board of Health and Welfare. Cancer Incidence in Sweden 2008. 2009.
16.
go back to reference Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–33.CrossRef Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–33.CrossRef
17.
go back to reference Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005;6:659–68.PubMedCrossRef Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005;6:659–68.PubMedCrossRef
18.
go back to reference Walther B, Johansson J, Johnsson F, Von Holstein CS, Zilling T. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg. 2003;238:803–12; discussion 812–4.PubMedCrossRef Walther B, Johansson J, Johnsson F, Von Holstein CS, Zilling T. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg. 2003;238:803–12; discussion 812–4.PubMedCrossRef
19.
go back to reference McCulloch P, Ward J, Tekkis PP. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ. 2003;327:1192–7.PubMedCrossRef McCulloch P, Ward J, Tekkis PP. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ. 2003;327:1192–7.PubMedCrossRef
20.
go back to reference Thompson AM, Rapson T, Gilbert FJ, Park KG. Hospital volume does not influence long-term survival of patients undergoing surgery for oesophageal or gastric cancer. Br J Surg. 2007;94:578–84.PubMedCrossRef Thompson AM, Rapson T, Gilbert FJ, Park KG. Hospital volume does not influence long-term survival of patients undergoing surgery for oesophageal or gastric cancer. Br J Surg. 2007;94:578–84.PubMedCrossRef
21.
go back to reference Rouvelas I, Jia C, Viklund P, Lindblad M, Lagergren J. Surgeon volume and postoperative mortality after oesophagectomy for cancer. Eur J Surg Oncol. 2007;33:162–8.PubMedCrossRef Rouvelas I, Jia C, Viklund P, Lindblad M, Lagergren J. Surgeon volume and postoperative mortality after oesophagectomy for cancer. Eur J Surg Oncol. 2007;33:162–8.PubMedCrossRef
22.
go back to reference Crestanello JA, Deschamps C, Cassivi SD, Nichols FC, Allen MS, Schleck C, et al. Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg. 2005;129:254–60.PubMedCrossRef Crestanello JA, Deschamps C, Cassivi SD, Nichols FC, Allen MS, Schleck C, et al. Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg. 2005;129:254–60.PubMedCrossRef
Metadata
Title
Intrathoracic Anastomotic Leakage and Mortality After Esophageal Cancer Resection: A Population-Based Study
Authors
Martin Rutegård, MD, PhD
Pernilla Lagergren, RN, PhD
Ioannis Rouvelas, MD, PhD
Jesper Lagergren, MD, PhD
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1926-6

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