Risk factors and countermeasures of anastomotic stricture after esophagogastrostomy

Abstract

Objective To investigate the risk factors of anastomotic stenosis after esophagogastrostomy, and to improve the life quality after esophagogastrostomy. Methods From June 2014 to June 2016, 138 patients (experimental group) with esophageal cancer who underwent anastomotic dilatation due to anastomotic stenosis in our thoracic endoscopy room were retrospectively analyzed, and 276 patients (control group) with esophageal cancer who could eat solid food at the same time were randomly selected. The effects of preoperative body mass index, preoperative swallowing, preoperative imaging examinations on anastomotic stenosis, location of lesion, surgical approach, anastomotic site, anastomotic mode, tumor length, pathological classification, pathological stage, and postoperative anastomotic leakage on postoperative anastomotic stenosis were analyzed by univariate and multivariate analysis. Results Univariate analysis showed that there were significant differences in pathological staging and anastomotic leakage (P 0.05). Dysphagia (P=0.05), tumor length (P=0.1), pathological stage (P=0.04) and anastomotic fistula (P<0.01) were included in logistic regression analysis, and the results showed that postoperative anastomotic leakage (OR=5.87, 95% CI: 2.65-13.01; P<0.01), tumor length which was less than 3 cm (OR=1.65, 95% CI: 1.01-2.67; P= 0.04) were the influencing factors of anastomotic stenosis. Preoperative swallowing was also a risk factor for anastomotic stenosis: semifluid patients were more likely to have anastomotic stenosis than fluid patients (OR=2.13, 95% CI: 1.32-3.45; P<0.01). Conclusions Anastomotic fistula is an independent risk factor for postoperative anastomotic stenosis. For patients with anastomotic fistula, early prophylactic esophageal dilatation is very important to prevent anastomotic stenosis. According to the results of multivariate analysis, patients with relatively mild dysphagia, relatively short tumor length and relatively early pathological stage are more likely to have anastomotic stenosis. For these patients, lateral anastomosis should be adopted to reduce postoperative anastomotic stenosis. Key words: Esophageal cancer; Anastomotic stricture; Anastomotic fistula; Tumor diameter