Intra-operative hypotensive episodes may be associated with post-operative esophageal anastomotic leak.

Abstract

This study aims to report the hypotensive episodes (HEs) during esophagectomy and their influence on the occurrence of anastomotic leak. Eighty-four patients underwent esophagectomy with gastric pull-up. Pre-, intra-, and post-operative data were prospectively collected. HEs were defined by systolic pressure decreasing more than 30% of the basal value for more than 5min. Nineteen patients had intra-operative HEs (22.6%). HEs were significantly more frequent in patients undergoing prone esophagectomy (P=0.001) and those with an epidural catheter (EC) (P=0.04) used during surgery. Among them, 15 were treated with vasopressors. There were six severe post-operative anastomotic leaks, which required surgery; leaks were significantly more common in patients with intra-operative HEs (21 vs 3.1%; P=0.02), especially those treated with vasopressive agents (20 vs 0%; P=0.008). Intra-operative use of EC can, in certain conditions, significantly influence gastric blood flow due to HEs. A higher incidence of severe leak occurred in patients experiencing intra-operative HEs. Several factors can lead to intra-operative HEs, and the perioperative use of an EC should be carefully evaluated.