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Association of level of anastomosis and anastomotic leak after esophagectomy in anterior mediastinal reconstruction

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Abstract

Aim

The purpose of this study was to investigate modifiable predisposing factors associated with anastomotic leak in the anterior mediastinal (AM) reconstruction route.

Methods

We reviewed the data on 154 patients who underwent esophagectomy and gastric tube reconstruction using the AM route between 2008 and 2016. The data included computed tomography (CT) scans with sagittal reconstruction of the thoracic section. The level of the esophagogastric anastomosis (LEA) and pretracheal distance (PTD) was measured from sagittal reconstructed CT images. Vascularization of the gastric tube was evaluated by postoperative endoscopy. Variables associated with anastomotic leak were determined using univariate and multivariate analyses.

Results

Anastomotic leak developed in 13 patients (8%). The cut-off level at which the anastomosis was less likely to develop a leak, as determined by Chi-square tests, was 1.5 cm for LEA and 1.3 cm for PTD. On univariate analysis, the factors that were significantly associated with the risk of anastomotic leak included diabetes, hand-sewn anastomosis, the LEA ≥ 1.5 cm, and severe mucosal degeneration. On multivariate analysis, diabetes (OR 4.7, 95% CI 1.29–17.2), LEA ≥ 1.5 cm (OR 20.1, 95% CI 3.15–128), and severe mucosal degeneration (OR 7.2, 95% CI 1.42–36.8) were found to be statistically significant independent risk factors.

Conclusion

Use of the AM route to place the cervical anastomosis within 1.5 cm above the suprasternal notch might avoid excessive pressure on the gastric tube from the surrounding structures, resulting in a reduction in the risk of an anastomotic leak.

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Authors and Affiliations

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

    Katsunori Nishikawa, Tetsuji Fujita, Yako Hasegawa, Yujiro Tanaka, Akira Matsumoto, Norio Mitsumori & Katsuhiko Yanaga

Authors
  1. Katsunori Nishikawa
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  2. Tetsuji Fujita
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  3. Yako Hasegawa
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  4. Yujiro Tanaka
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  5. Akira Matsumoto
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  6. Norio Mitsumori
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  7. Katsuhiko Yanaga
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Corresponding author

Correspondence to Katsunori Nishikawa.

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Ethical statement

All procedures were performed with the approval of the Ethics Committee of Jikei University Hospital in accordance with the revised Helsinki Declaration of 2000.

Conflict of interest

All authors have no conflicts of interest associated with this study.

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Nishikawa, K., Fujita, T., Hasegawa, Y. et al. Association of level of anastomosis and anastomotic leak after esophagectomy in anterior mediastinal reconstruction. Esophagus 15, 231–238 (2018). https://doi.org/10.1007/s10388-018-0619-7

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  • DOI: https://doi.org/10.1007/s10388-018-0619-7

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