title: Predictors and outcome of cervical anastomotic leakage after esophageal cancer surgery.
abstract: BACKGROUND
  Anastomotic leakage after esophagectomy remains an important source of postoperative morbidity in spite of advances in the management of these patients. The aim of this study is to identify the predictive factors of cervical anastomotic leakage and its consequences after esophagectomy in patients with esophageal cancer treated in a high volume cancer center.
  
  
  METHODS
  This retrospective study was conducted on 418 patients with esophageal carcinoma who underwent esophagectomy in a referral cancer center between 2001 and 2006. Demographic, clinicopathologic, and surgical data were collected from medical charts. Univariate and multivariate analyses were performed and odds ratio (OR) with 95% confidence intervals (CI 95% ) were calculated.
  
  
  RESULTS
  Predictive factors of leakage in univariate analysis were history of hypertension (P=0.003), diabetes mellitus (P=0.008), forced expiratory volume in one second percent predicted (FEV1%) (P=0.024), preoperative serum creatinine level (P=0.004), and degree of differentiation of the tumor (P=0.014); however, multivariate regression analysis identified history of hypertension (OR 7.2, [CI 95% :1.9 to 28.1]; P=0.004) and serum creatinine level > 0.85 mg/dl (OR 3.1, [CI 95% :1.04 to 9.04]; P=0.042) as independently significant risk factors. Pulmonary complications (P=0.042) and length of hospital stay (P < 0.0001) were observed significantly more in patients with anastomotic leakage. Cervical leakage was not associated with increased mortality rate (P=0.312).
  
  
  CONCLUSIONS
  Preoperative conditions like hypertension and higher creatinine levels predict development of cervical anastomotic leakage after esophageal cancer surgery. Postoperative consequences accompanying leakage include pulmonary complication and prolonged hospitalization.
authors.affiliation: Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran. aaminian@tums.ac.ir
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.forename: Nekoo
authors.initials: N
authors.lastname: Panahi
authors.forename: Rasoul
authors.initials: R
authors.lastname: Mirsharifi
authors.forename: Faramarz
authors.initials: F
authors.lastname: Karimian
authors.forename: Alipasha
authors.initials: A
authors.lastname: Meysamie
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.forename: Abbas
authors.initials: A
authors.lastname: Alibakhshi
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003404:Creatinine