Abstract
BackgroundEarly diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult. Estimation of an individual probability could help to establish preventive and diagnostic measures. The predictive impact of epidemiological, surgery-related data and laboratory parameters on the development of anastomotic dehiscence was investigated in the immediate perioperative period.MethodsRetrospective study in 412 patients with cervical esophagogastrostomy following esophagectomy. Epidemiological data, risk factors, underlying disease, pre-treatment- and surgery-related data, C-reactive protein and albumin levels pre-and post-operatively were evaluated. We applied univariable and multivariable logistic regression analysis and developed a nomogram for individual risk assessment.ResultsThere were 345 male, 67 female patients, mean aged 61.5 years; 284 had orthotopic, 128 retrosternal gastric pull-up; 331 patients had carcinoma, 81 non-malignant disease. Mean duration of operation was 184 min; 235 patients had manual, 113 mechanical and 64 semi-mechanical suturing; 76 patients (18.5%) developed anastomotic dehiscence clinically evident at mean 11.4 days after surgery. In univariable testing young age, retrosternal conduit transposition, manual suturing, high body mass index, high ASA and high postoperative levels of C-reactive protein were predictors for anastomotic leakage. These six parameters which had yielded a p < 0.1 in the univariable analysis, were entered into a multivariable analysis and a nomogram allowing the determination of the patient’s individual risk was created.ConclusionBy using the nomogram as a supportive measure in the perioperative management, the patient’s individual probability of developing an anastomotic leak could be quantified which may help to take preventive measures improving the outcome.
Highlights
Diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult
Anastomotic dehiscence could be detected in 24%, compared with 11% in semi-mechanical and mechanical anastomosis, respectively (Table 2)
ROC analysis revealed an Area under the ROC Curve = 0.7312. This clinical analysis demonstrates that young patient’s age, retrosternal transposition of the gastric conduit, manual anastomotic suturing, elevated body mass index (BMI), enhanced ASA score and high C-reactive protein (CRP) levels on the 3rd postoperative day may serve as predictors for anastomotic leakage following cervical esophagogastrostomy
Summary
Diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult. In univariable testing young age, retrosternal conduit transposition, manual suturing, high body mass index, high ASA and high postoperative levels of C-reactive protein were predictors for anastomotic leakage. These six parameters which had yielded a p < 0.1 in the univariable analysis, were entered into a multivariable analysis and a nomogram allowing the determination of the patient’s individual risk was created. Conclusion By using the nomogram as a supportive measure in the perioperative management, the patient’s individual probability of developing an anastomotic leak could be quantified which may help to take preventive measures improving the outcome
Published Version (Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have