title: Influence of preoperative radiation field on postoperative leak rates in esophageal cancer patients after trimodality therapy.
abstract: BACKGROUND
  Postoperative morbidities, such as anastomotic leaks, are common after trimodality therapy (chemoradiation followed by surgery) for esophageal cancer. We investigated for factors associated with an increased incidence of anastomotic leaks.
  
  
  METHODS
  Data from 285 esophageal cancer patients treated from 2000 to 2011 with trimodality therapy were analyzed. Anastomotic location relative to preoperative radiation field was assessed using postoperative computed tomographic imaging. Logistic regression was used to evaluate for factors associated with any or clinically relevant (CR) (≥ grade 2) leaks.
  
  
  RESULTS
  Overall anastomotic leak rate was 11% (31 of 285), and CR leak rate was 6% (17 of 285). Multivariable analysis identified body mass index (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.00-1.17; OR, 1.11, 95% CI, 1.01-1.22), three-field surgery (OR, 10.01; 95% CI, 3.83-26.21; OR, 4.83; 95% CI, 1.39-16.71), and within radiation field ("in-field") anastomosis (OR, 5.37; 95% CI, 2.21-13.04; OR, 8.63; 95% CI, 2.90-25.65) as independent predictors of both all grade and CR leaks, respectively. While patients with distal esophageal tumors and Ivor-Lewis surgery had the lowest incidence of all grade (6.5%) and CR leaks (4.2%), most of the leaks were associated with the anastomosis constructed within the field of radiation (in-field: 39% and 30% versus out-of-field: 2.6% and 1.0%, respectively, for total and CR leaks, p less than 0.0001, Fisher's exact test).
  
  
  CONCLUSIONS
  Esophagogastric anastomosis placed within the preoperative radiation field was a very strong predictor for anastomotic leaks in esophageal cancer patients treated with trimodality therapy, among other factors. Surgical planning should include a critical evaluation of the preoperative radiation fields to ensure proper anastomotic placement after chemoradiation therapy.
authors.affiliation: *Departments of Radiation Oncology, †Bioinformatics and Computational Biology, and ‡Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
authors.forename: Aditya
authors.initials: A
authors.lastname: Juloori
authors.forename: Susan L
authors.initials: SL
authors.lastname: Tucker
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000150:complications* / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies
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