Prevention of Esophageal-Stomach Anastomosis Leakage After Esophagectomy—an Analysis of 1243 Patients

Abstract

To summarize the tips for the prevention of esophageal anastomosis leakage. Improvement in clinical techniques and treatments has decreased anastomotic leakage occurrence, but it remains one of the main causes of death after esophageal and gastric surgery. After efforts to improve outcomes in the past 7 years, we observed only four cases of anastomotic leakage. Thus, here we summarize the technical details for peer reference. The tips for preventing esophageal-stomach anastomosis fistula include preoperative general nutrition improvement and esophageal edema-reducing measures. During surgery, technical prevention measures include protection and improvement of anastomosis technology. Postoperative measures include maintaining cervical anteflexion position, reduced anastomotic tension, and circulation-invigorating medicines to improve anastomotic circulation. Between January 2006 and December 2012, 1243 patients with esophageal cancer underwent resection of the esophagus and esophagogastrostomy. There were 885 male patients and 358 female patients, aged 40 to 78 years old, with an average age of 63.4 ± 5.6 years. The esophageal-stomach anastomotic leakage occurred in four cases, for an incidence rate of only 0.32% (4/1243). In these four detected cases, three patients recovered and were discharged from the hospital. One patient died. The application of improved technical measures may reduce postoperative esophageal anastomotic leakage incidence.