title: [Causes and prevention of anastomotic leakage after esophagectomy and reconstruction through different routes for esophageal cancer].
abstract: OBJECTIVE
  To compare the anastomotic leakage rates after esophagectomy and reconstruction through different routes for esophageal cancer and analyze the causes for higher anastomotic leakage rate after esophagectomy, systemic lymph node dissection and reconstruction through retrosternal route and its prevention.
  
  
  METHODS
  Data of 1105 cases of esophagectomy were reviewed retrospectively. Patients in group A (n=229) underwent esophagectomy through left thoracotomy and intrathoracic anastomosis, patients in group B (n=716), esophagectomy through right anterio-lateral thoracotomy and cervical reconstruction through posterior mediastinal route, patients in group C (n=160) esophagectomy, systemic lymph node dissection and cervical anastomosis through the retrosternal route.
  
  
  RESULTS
  The leakage rate was significantly higher (19.4%) in group C than that in group B (11.9%, P< 0.05) and much significantly higher than that in group A (2.2%, P< 0.01). In group C, there was no significant difference in leakage rate between the patients with hand-sewn or mechanical anastomosis (22.2% vs.11.6%, P=0.133), between the patients who had whole stomach or tube-typed gastric reconstruction (25% vs.15.6%, P=0.146). The leakage rate was significantly decreased from 23.3% to 9.1% after prolonged nasal-gastric drainage for seven days (P< 0.05).
  
  
  CONCLUSIONS
  The high anastomotic leakage rate after retrosternal reconstruction is mainly due to compression of the stomach in the anterior mediastinum. Prolonged nasogastric drainage is an effective way to decrease the leakage rate after systemic lymphadenectomy.
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China. vwtfang@hotmail.com
authors.forename: Wen-tao
authors.initials: WT
authors.lastname: Fang
authors.forename: Wen-hu
authors.initials: WH
authors.lastname: Chen
authors.forename: Li-ming
authors.initials: LM
authors.lastname: Fan
authors.forename: Ke-jian
authors.initials: KJ
authors.lastname: Cao
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.forename: Yong
authors.initials: Y
authors.lastname: Jiang
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000473:pathology*