Abstract
Abstract Background Benign strictures occur frequently following an esophagectomy, causing dysphagia, problems with eating, and a diminished overall quality of life. The aim of this study is to identify risk factors associated with anastomotic stenosis specified for anastomotic technique following esophagectomy for cancer. Methods This retrospective study included patients with esophageal and gastroesophageal junction cancer who underwent esophagectomy in a tertiary referral center between 2012 and 2022. Intrathoracic and cervical anastomoses were analyzed separately. Benign anastomotic stenosis was defined as the occurrence of postoperative dysphagia for which at least 1 endoscopic anastomotic dilation was needed. Possible predictive factors for anastomotic stenosis were analyzed with uni- and multivariate logistic regression. Results This study included 902 patients: 605 with an intrathoracic and 297 with a cervical anastomosis. Anastomotic stenosis was observed in 18.4% and 49.8% (p<0.001). Patients respectively requiring a median 4 and 7 dilations (p=0.001). Median of time to anastomotic stenosis was 99 and 78 days (p=0.001). In multivariate analysis of intrathoracic anastomosis, anastomotic leakage was a significant risk factor for stenosis (OR 2.034; 95% CI [1.116-3.708]). In patients without anastomotic leakage, stapler size 29mm was a negative predictor (OR 0.444; 95% CI [1.116-3.708]), immunosuppressants (OR 3.492; 95% CI [1.186-10.279]) and chronic pulmonary disease were significant risk factors (OR 2.717; 95% CI [1.293-5.707]). In multivariate analysis of cervical anastomosis, circular stapled anastomosis was a negative predictor (OR 0.350 95% [CI 0.188-0.652]) for stenosis. Conclusion This study identified the most important risk factors for anastomotic stricture after esophagectomy. Anastomotic leakage, the circular stapler diameter, and the circular stapled technique are factors that could be surgical modifiable, while patients taking immunosuppressants and with chronic pulmonary disease should be counseled for higher risk of stenosis.
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