title: Risk factors for anastomotic leakage following esophagectomy: Impact of thoracic epidural analgesia.
abstract: OBJECTIVE
  Anastomotic leakage (AL) is one of common complications after esophageal cancer surgery. Thoracic epidural analgesia (TEA) is often recommended in patients undergoing esophagectomy. However, the impact of TEA on AL is still controversial. Thus, we conducted this study to evaluate the effect of TEA on the occurrence of AL and identify risk factors for the development of AL following esophagectomy.
  
  
  METHODS
  Our retrospective study identified patients who underwent elective esophagectomy between July 2013 and July 2016. Univariate and multivariate logistics analyses and propensity score matching analysis were conducted to identify the risk factors for AL occurring within 30 days after operation.
  
  
  RESULTS
  Overall 30-day AL was 7.9%. Multivariate analysis revealed that surgical procedure (Sweet: referent; Ivor-Lewis: OR 2.854; 95%CI 1.726-4.718; Three-incision: OR 4.837; 95%CI 3.457-6.768) and surgeon (high-volume: referent; low-volume: OR 1.740; 95%CI 1.269-2.384) were independent risk factors for AL after esophagectomy. No statistically significant difference was observed in the incidences of AL between the epidural analgesia group and the intravenous analgesia group either before or after propensity score matching (9.1% vs 7.7%, P = 0.359; 8.3% vs 9.2%, P = 0.683).
  
  
  CONCLUSIONS
  TEA does not affect the AL risk after esophagectomy.
authors.affiliation: Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Gefei
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Linxin
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Yanpeng
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Chaobin
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Li
authors.identifier: http://orcid.org/0000-0002-1129-3393
authors.initials: L
authors.lastname: Sun
mesh_terms: D015360:Analgesia, Epidural; D057868:Anastomotic Leak / Q000209:etiology*; D002681:China; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D066231:Surgeons
keywords: analgesia; anastomotic leakage; epidural; esophageal cancer; esophagectomy; risk factors