title: [Analysis of risk factors and prognosis of esophagojejunal anastomotic leakage in gastric cancer patients after curative total gastrectomy].
abstract: OBJECTIVE
  To identify the risk factors of esophagojejunal anastomotic leakage (EJAL) and its impact on prognosis of gastric cancer patients after curative total gastrectomy.
  
  
  METHODS
  Clinical and follow-up data of 1254 gastric cancer patients who underwent radical total gastrectomy at the Department of Digestive Surgery, Xijing Hospital, from January 2012 to May 2015 were retrospectively collected. Risk factors of EJAL and prognostic factors of patients were analyzed respectively. In order to reduce the influences of other prognostic factors on survival, patients with and without EJAL were selected using Gmatch methods based on the results of prognostic factor analysis. Survival of those with or without EJAL was examined before and after match respectively.
  
  
  RESULTS
  EJAL occurred in 31 of 1 254 patients(2.5%). The leakage was diagnosed at a median of 6 (range, 4-12) days after surgery. Multivariate analysis demonstrated that preoperative low serum albumin(<35 g/L)(P=0.018), pulmonary insufficiency(P=0.006), long duration of operation(≥240 min)(P=0.001) were independent risk factors of EJAL. All the patients were followed up for 3-40(median 18) months. Multivariate analysis showed that age(≥65, P=0.000), intraoperative blood transfusion (P=0.016), EJAL (P=0.000), tumor location (distal, P=0.020; total, P=0.001), depth of invasion (T4, P=0.005) and lymph node metastasis (N2, P=0.002, N3, P=0.000) were prognostic predictors. Twenty-six patients with EJAL were successfully matched to 104 patients without EJAL in a ratio of 1/4 ratio. Patients with EJAL had a significantly worse overall 3-year survival rate than those without (44.3% vs. 66.7%, P=0.002).
  
  
  CONCLUSIONS
  EJAL after curative total gastrectomy leads to worse survival. Patients with preoperative low serum albumin, pulmonary insufficiency and long duration of operation should be taken care of during perioperative period to prevent the occurrence of EJAL.
authors.forename: Jinqiang
authors.initials: J
authors.lastname: Liu
authors.forename: Liu
authors.initials: L
authors.lastname: Hong
authors.forename: Xuewen
authors.initials: X
authors.lastname: Yang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Liu
authors.forename: Xiao
authors.initials: X
authors.lastname: Lian
authors.forename: Man
authors.initials: M
authors.lastname: Guo
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Shuao
authors.initials: S
authors.lastname: Xiao
authors.forename: Shushang
authors.initials: S
authors.lastname: Liu
authors.forename: Chao
authors.initials: C
authors.lastname: Nai
authors.affiliation: Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, China. zhanghw@fmmu.edu.cn.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000368:Aged; D057868:Anastomotic Leak; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate