Omental Flap Wrapping Around the Esophagogastric Anastomosis and Association with Anastomotic Leak in Esophagectomy for Esophageal Cancer: A Propensity Score-Matching Analysis.

Abstract

Anastomotic leakage after esophagectomy remains frequent and can cause surgery-related mortality. Wrapping the esophageal conduit anastomosis with a greater omental flap is a proposed method to reduce leakage. However, the usefulness of omental wrapping (OW) has not been elucidated. This study included 338 patients with esophageal cancer who underwent McKeown esophagectomy and reconstruction using a gastric conduit between April 2005 and August 2021. The study participants were divided into 2 groups: reconstructions with and without OW. We performed propensity score matching between the reconstructions with and without OW. The propensity score was calculated according to baseline characteristics, performance and physical statuses, presence of comorbidities, and types and details of the treatment procedures undergone. We included 338 patients (169 with OW and 169 without OW) in this study. After matching, all clinical and surgical features were statistically equivalent between the groups. Reconstruction and anastomosis with OW were significantly associated with decreased leakage (p = 0.016) and surgical site infection (p = 0.041). Reconstruction and anastomosis with OW also exhibited a trend toward more frequent stricture, although this was not statistically significant (p = 0.051). Independent risk factors for leakage were reconstruction without OW (odds ratio, 2.55; 95% CI, 1.234 to 5.285; p = 0.0088) and younger age (odds ratio, 1.06; 95% CI, 1.012 to 1.102; p = 0.011). OW can reduce leakage in the esophagogastric anastomosis. OW can be performed conveniently and may be recommended to reinforce the anastomotic site, which can improve short-term outcomes after esophagectomy for esophageal cancer.