Predictors and outcome of cervical anastomotic leakage after esophageal cancer surgery

Abstract

Anastomotic leakage after esophagectomy remains an important source of postoperative morbidity in spite of advances in the management of these patients. The aim of this study is to identify the predictive factors of cervical anastomotic leakage and its consequences after esophagectomy in patients with esophageal cancer treated in a high volume cancer center. This retrospective study was conducted on 418 patients with esophageal carcinoma who underwent esophagectomy in a referral cancer center between 2001 and 2006. Demographic, clinicopathologic, and surgical data were collected from medical charts. Univariate and multivariate analyses were performed and odds ratio (OR) with 95% confidence intervals (CI 95% ) were calculated. Predictive factors of leakage in univariate analysis were history of hypertension (P=0.003), diabetes mellitus (P=0.008), forced expiratory volume in one second percent predicted (FEV1%) (P=0.024), preoperative serum creatinine level (P=0.004), and degree of differentiation of the tumor (P=0.014); however, multivariate regression analysis identified history of hypertension (OR 7.2, [CI 95% :1.9 to 28.1]; P=0.004) and serum creatinine level > 0.85 mg/dl (OR 3.1, [CI 95% :1.04 to 9.04]; P=0.042) as independently significant risk factors. Pulmonary complications (P=0.042) and length of hospital stay (P < 0.0001) were observed significantly more in patients with anastomotic leakage. Cervical leakage was not associated with increased mortality rate (P=0.312). Preoperative conditions like hypertension and higher creatinine levels predict development of cervical anastomotic leakage after esophageal cancer surgery. Postoperative consequences accompanying leakage include pulmonary complication and prolonged hospitalization.