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Ulcer Scarring in the Gastric Conduit Is a Risk Factor for Anastomotic Leakage After Esophagectomy for Esophageal Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Anastomotic leakage (AL) is a serious complication after esophagectomy for esophageal cancer. The objective of this study was to identify the risk factors for AL.

Methods

Patients with esophageal cancer who underwent curative esophagectomy and cervical esophagogastric anastomosis between 2009 and 2019 (N = 346) and those between 2020 and 2022 (N = 17) were enrolled in the study to identify the risk factors for AL and the study to assess the association between the risk factors and blood flow in the gastric conduit evaluated by indocyanine green (ICG) fluorescence imaging, respectively.

Results

AL occurred in 17 out of 346 patients (4.9%). Peptic or endoscopic submucosal dissection (ESD) ulcer scars were independently associated with AL (OR 6.872, 95% CI 2.112–22.365) in addition to diabetes mellitus. The ulcer scars in the anterior/posterior gastric wall were more frequently observed in patients with AL than in those without AL (75.0% vs. 17.4%, P = 0.042). The median flow velocity of ICG fluorescence in the gastric conduits with the scars was significantly lower than in those without the scars (1.17 cm/s vs. 2.23 cm/s, P = 0.004).

Conclusions

Peptic or ESD ulcer scarring is a risk factor for AL after esophagectomy in addition to diabetes mellitus. The scars in the anterior/posterior gastric wall are significantly associated with AL, impairing blood flow of the gastric conduit. Preventive interventions and careful postoperative management should be provided to minimize the risk and severity of AL in patients with these risk factors.

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Data Availability

The datasets used and/or analyzed in this study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 951-8510, Japan

    Daisuke Motegi, Hiroshi Ichikawa, Yusuke Muneoka, Yosuke Kano, Kenji Usui, Takaaki Hanyu, Takashi Ishikawa, Yuki Hirose, Kohei Miura, Yosuke Tajima, Yoshifumi Shimada, Jun Sakata & Toshifumi Wakai

  2. Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-Cho, Chuo-Ku, Niigata City, Niigata, 951-8566, Japan

    Takeo Bamba & Satoru Nakagawa

  3. Department of Surgery, Shibata Prefectural Hospital, 1-2-8 Hon-Cho, Shibata City, Niigata, 957-8588, Japan

    Takaaki Hanyu

  4. Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma City, Niigata, 949-7302, Japan

    Shin-ichi Kosugi

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  1. Daisuke Motegi
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Contributions

D. Motegi: protocol/project development, data collection and analysis, manuscript writing.

H. Ichikawa: protocol/project development, data collection and analysis, manuscript writing and editing.

T. Bamba: data collection and management, manuscript editing.

Y. Muneoka: data collection and analysis, manuscript editing.

Y. Kano: data collection and management, manuscript editing.

K. Usui: data collection and management, manuscript editing.

T. Hanyu: data collection and management, manuscript editing.

T. Ishikawa: data management and analysis, manuscript editing.

Y. Hirose: data interpretation, manuscript editing.

K. Miura: data interpretation, manuscript editing.

Y. Tajima: data interpretation, manuscript editing.

Y. Shimada: protocol/project development, manuscript editing.

J. Sakata: protocol/project development, manuscript editing.

S. Nakagawa: data collection and management, manuscript editing, supervision of the study.

S. Kosugi: data collection and management, manuscript editing, supervision of the study.

T. Wakai: protocol/project development, manuscript editing, supervision of the study.

All the authors revised the manuscript critically for content and approved the final manuscript.

Corresponding author

Correspondence to Hiroshi Ichikawa.

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Ethics Approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration. This study was approved by the Human Ethics Review Committee of Niigata University (#2020–0106). The need for written informed consent was waived due to the retrospective observational nature of the study, and brief information on this study was disclosed on the Niigata University website to ensure patients had an opportunity to refuse their participation in the study (opt-out method).

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Motegi, D., Ichikawa, H., Bamba, T. et al. Ulcer Scarring in the Gastric Conduit Is a Risk Factor for Anastomotic Leakage After Esophagectomy for Esophageal Cancer. J Gastrointest Surg 27, 250–261 (2023). https://doi.org/10.1007/s11605-022-05545-0

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