title: Intra-operative hypotensive episodes may be associated with post-operative esophageal anastomotic leak.
abstract: This study aims to report the hypotensive episodes (HEs) during esophagectomy and their influence on the occurrence of anastomotic leak. Eighty-four patients underwent esophagectomy with gastric pull-up. Pre-, intra-, and post-operative data were prospectively collected. HEs were defined by systolic pressure decreasing more than 30 % of the basal value for more than 5 min. Nineteen patients had intra-operative HEs (22.6 %). HEs were significantly more frequent in patients undergoing prone esophagectomy (P = 0.001) and those with an epidural catheter (EC) (P = 0.04) used during surgery. Among them, 15 were treated with vasopressors. There were six severe post-operative anastomotic leaks, which required surgery; leaks were significantly more common in patients with intra-operative HEs (21 vs 3.1 %; P = 0.02), especially those treated with vasopressive agents (20 vs 0 %; P = 0.008). Intra-operative use of EC can, in certain conditions, significantly influence gastric blood flow due to HEs. A higher incidence of severe leak occurred in patients experiencing intra-operative HEs. Several factors can lead to intra-operative HEs, and the perioperative use of an EC should be carefully evaluated.
authors.affiliation: General and Minimally Invasive Surgery, Humanitas Clinical and Research Hospital, Rozzano, Italy. uberto.fumagalli@humanitas.it.|Esophagogastric Surgery, Humanitas Clinical and Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy. uberto.fumagalli@humanitas.it.
authors.forename: Uberto
authors.initials: U
authors.lastname: Fumagalli
authors.affiliation: General and Minimally Invasive Surgery, Humanitas Clinical and Research Hospital, Rozzano, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Melis
authors.affiliation: Anesthesiology and Critical Care, Humanitas Clinical and Research Hospital, Rozzano, Italy.
authors.forename: Jana
authors.initials: J
authors.lastname: Balazova
authors.affiliation: Anesthesiology and Critical Care, Humanitas Clinical and Research Hospital, Rozzano, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Lascari
authors.affiliation: Biostatistic Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morenghi
authors.affiliation: General and Minimally Invasive Surgery, Humanitas Clinical and Research Hospital, Rozzano, Italy.|Digestive Surgery, University Vita e Salute, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak; D001794:Blood Pressure / Q000502:physiology*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000601:surgery
keywords: Anastomotic healing; Anastomotic leak; Esophagectomy; Hypothension; Intra-operative fluid management; Thoracic epidural analgesia