333. HIGH CERVICAL ANASTOMOSIS USING NARROW GASTRIC TUBE CAN REDUCE LEAKAGE AFTER MCKEOWN ESOPHAGECTOMY

Abstract

Abstract Background Anastomotic leakage is one of the most serious complications after esophagectomy. High cervical anastomosis with narrow gastric tube has the potential to reduce the leakage after McKeown esophagectomy. Methods A total of 533 patients who received McKeown radical resection for esophageal cancer in Shanghai Chest Hospital from March 2018 to March 2023 were included in this study, including 281 patients in the normal anastomosis (NA) group and 252 patients in the high anastomosis (HA) group. Potential confounding factors in baseline characteristics were balanced by 1:1 propensity score matching (PSM). We compared the pathological and perioperative results before and after matching between the HA group and NA group, and finally used univariate and multivariate logistic analysis to analyze the independent risk factors of anastomotic leakage. Results After matching, 190 patients remained in both groups. In the comparison of pathological and surgical results, we found that the HA group had an advantage in lymph node harvest (Before matching: 21.3 ± 9.7 vs. 15.8 ± 7.5, p < 0.001; After matching: 21.1 ± 10.0 vs. 15.8 ± 7.7, p < 0.001). There were no significant differences in operation time, blood loss and R0 resection rate between the two groups after matching. The grade of tumor differentiation in HA group was better than that in NA group (p < 0.001), and the pathological staging was earlier than that in NA group (p < 0.001). Overall postoperative complications, including pulmonary infection (p < 0.001), anastomotic leakage (p < 0.001), recurrent laryngeal nerve paralysis (p = 0.031), and pleural effusion (p < 0.001), were significantly lower in the HA group than those in the NA group. Multivariate analysis indicated that age > 65 [odds ratio (OR) = 1.433, 95% confidence interval (CI) 1.248–1.753; p = 0.003], T4a (OR = 1.19, 95% CI 1.023–1.629; p = 0.016), Neoadjuvant treatment (OR = 0.075, 95% CI 0.038–0.150; p < 0.001) and HA (OR = 0.631, 95% CI 0.213–0.707; p = 0.014) were independent predictors for anastomotic leakage. Conclusions For patients undergoing McKeown esophagectomy, high anastomosis can effectively reduce the incidence of anastomotic leakage and reduce overall perioperative complications. It is a recommended optimized surgical procedure.