Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer.
OBJECTIVE
The aim of this study was to investigate the correlation between intraoperative anastomotic troubles and the incidence of esophagojejunal anastomotic leakage (EJAL), and to identify risk factors for EJAL after elective gastrectomy for gastric cancer.


METHODS
This study reviewed the medical and surgical records of 327 patients who underwent elective gastrectomy followed by esophagojejunostomy. A multivariate analysis was performed to determine the risk factors for EJAL.


RESULTS
An EJAL occurred in 19 patients (5.8 %). A multivariate analysis demonstrated that hemoglobin A1c ≥7.0 % (p < 0.01), chronic renal failure (p < 0.01), proximal gastrectomy (p < 0.05), and anastomotic trouble during construction of the esophagojejunostomy (p < 0.01) were independent predictors for EJAL. Anastomotic trouble during construction of esophagojejunostomy occurred in 20 patients (6.1 %), and EJAL occurred in 6 of these 20 patients (30 %). Four of ten patients (40 %) in whom an incomplete anastomosis was repaired by suturing during surgery had an EJAL, while none of seven patients who underwent re-anastomosis had this complication.


CONCLUSIONS
EJAL is strongly associated with intraoperative technical errors. To reduce this complication, proper anastomotic techniques are required. Re-anastomosis should be performed when an incomplete anastomosis is discovered during surgery.
Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8522, Japan. kmigita@naramed-u.ac.jp
Kazuhiro
K
Migita
Tomoyoshi
T
Takayama
Sohei
S
Matsumoto
Kohei
K
Wakatsuki
Koji
K
Enomoto
Tetsuya
T
Tanaka
Masahiro
M
Ito
Yoshiyuki
Y
Nakajima
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology; D017558:Elective Surgical Procedures; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery; D017792:Surgical Stapling / Q000009:adverse effects