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Risk stratification of anastomotic leakage using eGFR and FIB-4 index in patients undergoing esophageal cancer surgery

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Abstract

Purpose

Renal insufficiency and liver cirrhosis are identified as independent risk factors for anastomotic leakage (AL) after esophagectomy. However, research evaluating the incidence of AL using quantitative data to measure renal function and liver fibrosis remain to be limited. Therefore, this study was conducted to evaluate postoperative AL after esophagectomy using estimated glomerular filtration rate (eGFR) and fibrosis-4 (FIB-4) index.

Methods

In total, 184 patients who underwent esophagectomy were included in this study; then, they were divided into the non-AL group (n = 161) and AL group (n = 23), after which their background data and intraoperative and postoperative outcomes were compared. In addition, risk factors for AL were evaluated using a logistic regression model.

Results

Preoperative body mass index of ≥21.5 kg/m2, hemoglobin A1c level of ≥7.3%, FIB-4 index of ≥1.44, and eGFR of <59 ml/min/1.73 m2 were found to be significantly frequent in the AL group compared with the non-AL group. Multivariate analysis revealed FIB-4 index of ≥1.44 (p = 0.013; OR, 3.780; 95% CI, 1.320–10.800) and eGFR of <59 ml/min/1.73 m2 (p = 0.018; OR, 3.110; 95% CI, 1.220–8.020) as the independent risk factors for AL. In addition, we stratified the patients into three groups based on the incidence of AL as follows: low risk (5.5%, low FIB-4 index), intermediate risk (13.0%, high FIB-4 index and eGFR), and high risk (37.5%, high FIB-4 index and low eGFR).

Conclusion

Preoperative eGFR and FIB-4 index were found to be useful markers to predict AL after esophagectomy.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Keita Takahashi, Katsunori Nishikawa, Yuichiro Tanishima, Yoshitaka Ishikawa, Takahiro Masuda, Takanori Kurogochi, Masami Yuda, Yujiro Tanaka, Akira Matsumoto, Fumiaki Yano & Ken Eto

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  1. Keita Takahashi
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  2. Katsunori Nishikawa
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  3. Yuichiro Tanishima
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  4. Yoshitaka Ishikawa
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  5. Takahiro Masuda
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  6. Takanori Kurogochi
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Corresponding author

Correspondence to Keita Takahashi.

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This study protocol was approved by the institutional review board of the Jikei University School of Medicine (28-321).

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The need for informed consent was waived because of the retrospective design of the study.

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Takahashi, K., Nishikawa, K., Tanishima, Y. et al. Risk stratification of anastomotic leakage using eGFR and FIB-4 index in patients undergoing esophageal cancer surgery. Langenbecks Arch Surg 406, 1867–1874 (2021). https://doi.org/10.1007/s00423-021-02272-z

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  • DOI: https://doi.org/10.1007/s00423-021-02272-z

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