Prevalence and outcome of esophagogastric anastomotic leak after esophagectomy in a UK regional cancer network.
The aim of this study was to determine the contemporary prevalence, outcome, and survival after esophagogastric anastomotic leakage (EGAL) following esophagectomy by a regional upper gastrointestinal cancer network and to investigate etiological factors. Two hundred forty consecutive patients underwent esophagectomy over a 10-year period (median age 61 [31-79] years, 147 transthoracic and 93 transhiatal esophagectomy, 105 neoadjuvant chemotherapy, 49 chemoradiotherapy). The primary outcome measures were the development of EGAL and survival. Twenty patients developed EGAL (8.3%, 15 managed conservatively, 5 reoperation). Overall operative mortality was 2% (5 patients in total, 1 after EGAL). Median, 1 and 2-year survival was 22 months, 73% and 50%, in patients after EGAL, compared with 31 months, 80% and 56%, in patients who did not suffer EGAL (P= 0.314). On multivariate analysis, low body mass indices (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11-0.79, P= 0.016), individual surgeon (HR 1.21, 95% CI 1.02-1.43, P= 0.02), and neoadjuvant chemotherapy (HR 3.28, 95% CI 1.16-9.22, P= 0.024) were significantly associated with the development of EGAL. EGAL following esophagectomy remained common, but associated mortality was less common than reported in earlier Western series and long-term survival was unaffected.
Escofet
X
X
South East Wales Cancer Network, Departments of Surgery, University Hospital of Wales, Cardiff CF14 4XW, UK.
Manjunath
A
A
Twine
C
C
Havard
T J
TJ
Clark
G W
GW
Lewis
W G
WG
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000401:mortality; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D004944:Esophagoplasty / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000401:mortality; D013502:General Surgery / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D017792:Surgical Stapling / Q000706:statistics & numerical data; D015996:Survival Rate; D013536:Suture Techniques / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology