title: Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery.
abstract: BACKGROUND
  Despite the development of the surgical technique and improvements in perioperative management, anastomotic leakage still occurs at esophagojejunal anastomoses after total or proximal gastrectomy. Anastomotic leakage is one of the major complications of concern, chiefly because it can lead to death. The objective of the present study was to identify the risk factors for esophagojejunal anastomotic leakage.
  
  
  METHODS
  The study was based on retrospective analysis of the data of a total of 1,640 consecutive patients who underwent total, proximal, or completion gastrectomy, including esophagojejunal anastomosis, between 1999 and 2008.
  
  
  RESULTS
  Thirty-five patients (2.1 %) developed anastomotic leakage. Univariate analysis revealed patient age, pulmonary insufficiency, lymph node dissection, combined resection of other organs, omental resection, operative time, blood loss, intraoperative blood transfusion, and postoperative creatinine level were the significant factors influencing anastomotic leakage. Multivariate analysis identified pulmonary insufficiency and the duration of the operation as the predictors of anastomotic leakage.
  
  
  CONCLUSIONS
  To avoid leakage, surgeons should take care in creating the anastomosis in gastrectomy patients, particularly in cases of poor pulmonary function or when the procedure requires a longer operation.
authors.affiliation: Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Deguchi
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukagawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Morita
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohashi
authors.forename: Makoto
authors.initials: M
authors.lastname: Saka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Katai
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak; D015992:Body Mass Index; D004947:Esophagus / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008197:Lymph Node Excision; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery; D013997:Time Factors