Abstract
BackgroundMinimally invasive McKeown esophagectomy is an important surgical approach for esophageal cancer. Anastomotic leak is one of its common and serious complications. We assumed that the preoperative risk factors and postoperative indicators would predict or detect anastomotic leak.MethodsBetween December 2016 and July 2017, patients underwent minimally invasive McKeown esophagectomy were identified and their preoperative variables and postoperative test indicators were recorded. Fisher’s exact test, 2-tailed unpaired t test, nonparametric test and logistic regression were used to compare these datum between patients with or without anastomotic leak (AL). Receiver Operator Characteristic (ROC) curve was used to identify the best cut-off value of drainage amylase concentration for distinguishing anastomotic leak.ResultsIn all the 96 patients included, 12 patients were diagnosed as anastomotic leak by the esophagram. No differences in preoperative variables were observed between patients with and without AL. Patients in AL group appeared to have a lower prealbumin concentration in AL group on POD (postoperative day) 4(P = 0.05), POD 5(P = 0.04), POD 6 (P = 0.06). Prealbumin concentration cutoff value of 128 g/L on postoperative day 5 is 100.00% sensitive and 50.00% specific for predicting esophageal leaks. Drain amylases levels were higher in patients with anastomotic leak than those without anastomotic leak on POD 3(P = 0.03), POD 4(P = 0.01), POD 5(P < 0.001), POD 6(P < 0.001). The drain amylase cutoff value of 85 IU/L on postoperative day 4 was 75.00% sensitive and 84.00% specific for detecting esophageal leaks; the cutoff value of 65 IU/L on postoperative day 5 was 91.67% sensitive and 80.77% specific. The cutoff of 55/L on POD 6 is 100% sensitive and 86.96% specific.ConclusionDrainage amylase concentration on postoperative days may help to discover anastomotic leak in early stage after minimally invasive McKeown esophagectomy. Prealbumin concentration below 128 g/L on POD 5 might be potential risk factor for anastomotic leak.
Highlights
Invasive McKeown esophagectomy is an important surgical approach for esophageal cancer
The mean age is 62. 71 patients received jejunostomy while 25 patients accepted nasojejunal tubes.12 patients were as diagnosed as anastomotic leak by esophagram (12.5%)
In order to distinguish the risk factors among the patient characteristics for anastomotic leak, the patients were divided into two groups according to whether they suffered from anastomotic leakage
Summary
Invasive McKeown esophagectomy is an important surgical approach for esophageal cancer. We assumed that the preoperative risk factors and postoperative indicators would predict or detect anastomotic leak. Anastomotic leak is a common and serious complication among esophagectomy patients [1, 2]. With the development of both surgical technique and perioperative management, the incidence of AL has decreased over these years, especially in minimally invasive esophagectomy, occurring in 2–2.96% of patients undergoing Ivor-Lewis esophagectomy while 6.6–13.64% receiving McKeown esophagectomy [3, 4]. Even the anastomosis is close to the cervical incision in McKeown esophagectomy, the signs of leak are not always obvious enough for early recognition and management, resulting in serious infection in neck, mediastinum and even chest [8, 9]. The postoperative indicators were recorded and analyzed to assess whether they could detect or predict anastomotic leak
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