Analysis of Risk factors of anastomotic leakage after minimally invasive esophagectomy with circular cervical anastomosis

Abstract

OBJECTIVES Esophagectomy is a high-risk surgical procedure with significant postoperative morbidity and mortality. Anastomotic leakage is still one of the most serious complications after anterior resection for esophageal carcinoma. This study aimed to analyze the risk factors after minimally invasive cervical anastomosis of esophageal cancer and postoperative mortality. METHODS This was a retrospective study of 312 minimally invasive cervical anastomosis of esophageal cancer in a single institute between 2013 and 2016. The anastomotic level and perioperative confounding factors were analyzed by univariate and multivariate logistic regression to identify potential risk factors for postoperative leakage. RESULTS Total 312 patients were evaluated. Overall leak rate was 10.6%. In-hospital or 30-day mortality was 0%. Only 3 patients received intensive care unit due to postoperative complications and mean hospital stay was 14.22(± 7.70) days. Univariate analysis showed that the following variables were related to the incidence of anastomotic leakage: neoadjuvant chemotherapy before operation (p = 0.007); body mass index (BMI) (p = 0.000); diabetes (p = 0.001); operation time (p = 0.006). Multivariable analysis identified diabetes [P = 0.032, odds ratio (OR) 2.637, 95% confidence interval (CI): 1.087–6.393], BMI [P = 0.003, odds ratio (OR) 1.223, 95% confidence interval (CI): 1.070–1.399] and operation time [P = 0.033, odds ratio (OR) 1.012, 95% confidence interval (CI): 1.001–1.024] as the risk factors of anastomotic leakage. CONCLUSIONS Diabetes, operation time and BMI are independent prognostic factors for cervical anastomotic leakage of minimally invasive esophageal cancer. Cervical anastomotic leakage will not affect the short-term survival of the patients.