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Risk factors for anastomotic leakage after surgical resections for esophageal cancer

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Abstract

Purpose

Surgery for esophageal cancer is a challenging procedure that is associated with a high rate of complications such as sepsis, nutritional disorders, and anastomotic leakage (AL). The rate of complications following esophageal surgery rises exponentially in the presence of risk factors. This study aims to identify the risk factors for AL following esophageal cancer surgery.

Methods

In this retrospective study, we recorded comorbidities, tumor specific factors, nutritional status, and surgical complications of all patients who underwent surgical resections for esophageal cancers between January 2015 and December 2019. The occurrence of potential risk factors for AL was compared between groups with and without AL. We analyzed the categorical variables by Chi-square or Fisher’s exact test, and the continuous variable by the Mann-Whitney U test and multivariable regression analyses.

Results

From 92 patients, AL was found in 12 (13%) patients. All cases with AL had hypoproteinemia; a protein level < 5 g/dl was an independent risk factor for AL (p value 0.009). The logistic regression analysis showed a positive correlation between hypoproteinemia and AL (coefficient 1.83, significance 0.01). Additionally, squamous cell carcinoma (SCC) of the esophagus had a positive correlation with AL (coefficient 1.89, significance 0.01).

Conclusion

In our study, hypoproteinemia and SCC were significant risk factors for AL after esophageal cancer surgery. Optimization of preoperative hypoproteinemia using a standardized nutritional protocol is recommended. More research is essential to determine the correlation of SCC with AL.

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Data availability

Data are available from the corresponding author on request.

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Authors and Affiliations

  1. Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany

    Jonas Herzberg, Tim Strate & Human Honarpisheh

  2. Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates

    Salman Yousuf Guraya

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  1. Jonas Herzberg
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  2. Tim Strate
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  3. Salman Yousuf Guraya
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  4. Human Honarpisheh
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Jonas Herzberg and Salman Yousuf Guraya. The first draft of the manuscript was written by Jonas Herzberg and Salman Yousuf Guraya. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jonas Herzberg.

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Herzberg, J., Strate, T., Guraya, S.Y. et al. Risk factors for anastomotic leakage after surgical resections for esophageal cancer. Langenbecks Arch Surg 406, 1859–1866 (2021). https://doi.org/10.1007/s00423-021-02139-3

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