Predictive factors for anastomotic leakage in the neck after retrosternal reconstruction for esophageal cancer.
OBJECTIVE
Anastomotic leakage after transthoracic esophagectomy for esophageal cancer can induce life-threatening morbidity. This study investigated the predictive factors for anastomotic leakage in the neck after retrosternal reconstruction.


METHODS
A total of 129 esophageal carcinoma patients undergoing transthoracic esophagectomy and esophagogastric anastomosis in the neck via a retrosternal approach were enrolled between April 1985 and March 2002. Predictive factors for anastomotic leakage were statistically evaluated. In a preliminary study using 18 cases, thoracic inlet space (TIS) was recommended to be extended more than 700 mm2.


RESULTS
Partial resection of the bony structures was performed in 32 patients. The method of anastomosis and partial resection of bony structures according to the TIS independently influenced the likelihood of anastomotic leakage, with hand-sewn anastomosis and an absence of partial resection increasing its occurrence.


CONCLUSIONS
Stapled anastomosis following the partial resection of the sternum and the left clavicle is recommended to avoid anastomotic leakage. These findings should be clarified by a randomized controlled study in a high-volume hospital.
Department of Surgery, Gastroenterological Center Yokohama City University, Minami-ku, Yokohama 232-0024, Japan. s0714@med.yokohama-cu.ac.jp
Chikara
C
Kunisaki
Hirochika
H
Makino
Hirotoshi
H
Akiyama
Masato
M
Nomura
Yuichi
Y
Otsuka
Hidetaka A
HA
Ono
Takashi
T
Kosaka
Yasuyuki
Y
Kojima
Ryo
R
Takagawa
Hiroshi
H
Shimada
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019651:Plastic Surgery Procedures; D017792:Surgical Stapling