title: The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer.
abstract: OBJECTIVE
  Anastomotic leakage (AL) after esophagectomy is associated with high rates of postoperative morbidity and mortality. In cases with leakage, a refractory fistula (RF) is sometimes recognized after esophagectomy. The aim of this study was to evaluate the risk factors for RF after esophagectomy with gastric tube reconstruction.
  
  
  METHODS
  This study enrolled 244 consecutive esophageal cancer patients who had undergone esophagectomy with gastric tube reconstruction. RF was defined as a noncurative anastomotic site-cutaneous fistula that had been present for more than 2 months. We evaluated the risk factors for RF.
  
  
  RESULTS
  AL occurred in 30 patients (12.3%). There was one mortality case (0.4%) due to mediastinitis caused by AL in the present series. A multivariate analysis revealed that the subcutaneous route was an independent risk factor for AL (OR 4.42, 95% CI 1.42-13.8, p = 0.01), and that the subcutaneous route was an independent risk factor for RF (OR 13.30, 95% CI 2.50-71.30, p = 0.0024).
  
  
  CONCLUSIONS
  The results of this retrospective study suggest that subcutaneous route was associated with an increased risk of RF after esophagectomy with gastric tube reconstruction. The preoperative identification of risk factors may contribute to the prevention of postoperative AL and RF.
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Ippei
authors.initials: I
authors.lastname: Yamana
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takeno
authors.forename: Teppei
authors.initials: T
authors.lastname: Yamada
authors.forename: Keisuke
authors.initials: K
authors.lastname: Sato
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004944:Esophagoplasty / Q000009:adverse effects*; D005260:Female; D005402:Fistula / Q000097:blood / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016879:Salvage Therapy; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D013270:Stomach / Q000601:surgery
chemical_list: D012709:Serum Albumin