Abstract
Backgrounds and aimAnastomotic leak (AL) following esophagectomy for esophageal cancer (EC) remains an important cause of prolonged hospitalization and impaired quality of life. Recently, indocyanine green (ICG) fluorescein imaging has been used to evaluate the gastric conduit blood supply during EC surgery. Although several factors have been reported to be associated with AL, no studies have evaluated the relationships between risk factors for AL, including ICG fluorescein imaging. The purpose of this study was to investigate the risk factors associated with AL following esophagectomy and to evaluate the impact of ICG fluorescein imaging of the gastric conduit during EC surgery.MethodsOne hundred and twenty patients undergoing esophagectomy with esophagogastric anastomosis for EC were enrolled in this retrospective study. Clinicopathological factors, preoperative laboratory variables, and surgical factors, including ICG fluorescence imaging, were analyzed to determine their association with AL. Univariate and multivariate logistic regression analysis was used to evaluate the impact of each of these factors on the incidence of AL.ResultsAmong the 120 patients enrolled in the study, 10 (8.3%) developed AL. Univariate analysis demonstrated an increased risk of AL in patients with a high-neutrophil-to-lymphocyte ratio (p = 0.0500) and in patients who did not undergo ICG fluorescein imaging (p = 0.0057). Multivariate analysis revealed that the absence of ICG imaging was an independent risk factor for AL (p = 0.0098).ConclusionsUsing ICG fluorescein imaging to evaluate blood flow in the gastric conduit might decrease the incidence of AL following EC surgery.
Highlights
Death due to esophageal cancer (EC) is the sixth most common form of cancer-related mortality worldwide due to the high malignant potential of EC and its poor prognosis [1]
We found that the absence of indocyanine green (ICG) fluorescein imaging was an independent risk factor for anastomotic leak (AL) following EC surgery [HR 9.0740, 95% confidence interval (CI) 1.5923–171.2574, p = 0.0098]
Cited risk factors for AL include the number of preoperative comorbidities, advanced pathologic stage, nutritional status, previous esophagogastric operations, neoadjuvant therapy, anastomotic location, and anastomotic technique [22]
Summary
Death due to esophageal cancer (EC) is the sixth most common form of cancer-related mortality worldwide due to the high malignant potential of EC and its poor prognosis [1]. Anastomotic leak (AL) following esophagectomy remains an important source of in-hospital morbidity and mortality. AL is associated with a range of complications, including mediastinitis, sepsis, acute respiratory distress syndrome, and death [3, 4], as well as prolonged hospitalization, increased costs of medical treatment, and decreased quality of life. The reported prevalence of AL ranges from 5 to 25% [6,7,8]. In a recent report based on a nationwide Japanese web-based database, AL was observed in 711 of 5354 patients undergoing esophagectomy (13.3%) [9]. No precise consensus exists, various risk factors for AL following esophagectomy have been identified [8, Esophagus (2017) 14:351–359
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