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Esophagojejunal anastomotic fistula: a major issue after radical total gastrectomy

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Abstract

Gastric cancer surgery has evolved considerably over the past years, with substantial improvement on outcomes. Meanwhile, esophagojejunal anastomotic fistula (EJF) continues to impair postoperative results. This study aimed to assess EJF regarding its incidence, risk factors, management and the impact on overall survival. We retrospectively analyzed 258 consecutive patients who underwent total or completion gastrectomy for GC from 2009 and 2017. Clinicopathological characteristics analysis was performed comparing patients who developed EJF with patients with other clinical or surgical complications, as well as patients without any postoperative complications. Fifteen (5.8%) patients had EJF and 81 (31.4%) had other complications (including other surgical fistulas). The median time of EJF diagnosis was on the eighth postoperative day (range 3–76). Completion gastrectomy (p = 0.048) and longer hospital stay (p < 0.001) were associated with the occurrence of EJF. The surgical mortality of patients with EJF was higher than in non-EJF patients (26.7% vs. 4.5%; p < 0.001). Nine patients were treated conservatively and six required surgery. The mortality rate of EJF was 11.1% and 50% in patients who underwent conservative and surgical treatment, respectively. Patients with other complications and patients with EJF had worse survival compared to patients without any complication (p = 0.004 and p = 0.013, respectively). Completion gastrectomy is the main risk factor for EJF occurrence. Still, EJF is associated with high postoperative mortality, longer hospital stay and has a negative impact on long-term survival.

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Acknowledgements

The authors thank other members of the service involved in gastric cancer treatment: Donato R. Mucerino, Carlos E. Jacob (im memoriam), Osmar K. Yagi, Claudio J.C. Bresciani, Marcelo Mester, Amir Charruf, Cynthia Chiaradia, Rodrigo Jose de Oliveira and Fabio P. Lopasso.

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This study was not funded.

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Authors and Affiliations

  1. Cancer Institute (ICESP), Hospital das Clínicas, University of São Paulo Medical School, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil

    Leandro Cardoso Barchi, Marcus Fernando Kodama Pertille Ramos, Marina Alessandra Pereira, André Roncon Dias, Ulysses Ribeiro-Júnior, Bruno Zilberstein & Ivan Cecconello

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  1. Leandro Cardoso Barchi
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  2. Marcus Fernando Kodama Pertille Ramos
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  6. Bruno Zilberstein
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  7. Ivan Cecconello
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Contributions

LCB and MFKPR: study design, data retrieval, critical analysis, and draft of the manuscript. MAP: data retrieval and statistical analysis. ARD: data retrieval and review of the manuscript. URJ, BZ, and IC: critical analysis and review of the manuscript.

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Correspondence to Leandro Cardoso Barchi.

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Barchi, L.C., Ramos, M.F.K.P., Pereira, M.A. et al. Esophagojejunal anastomotic fistula: a major issue after radical total gastrectomy. Updates Surg 71, 429–438 (2019). https://doi.org/10.1007/s13304-019-00659-8

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