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Preoperative Glycosylated Hemoglobin Levels Predict Anastomotic Leak After Esophagectomy with Cervical Esophagogastric Anastomosis

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Abstract

Background

Patients with diabetes are considered at increased risk of delayed wound healing and infectious complications, yet the relationship between diabetes and anastomotic leak (AL) remains unclear. Given that glycosylated hemoglobin (HbA1c) is a validated indicator of the long-term glycemic state, we evaluated the relationship between preoperative HbA1c levels and AL after esophagectomy.

Methods

We assessed 300 consecutive patients who underwent esophagectomy reconstructed with cervical esophagogastric anastomosis between 2011 and 2015. HbA1c levels were measured within 90 days before esophagectomy. We performed comparison between the patients with and without diabetes. In addition, the predictive factors for AL, as well as the relationship between HbA1c levels and AL, were investigated.

Results

Among the 300 patients, 35 had diabetes. The overall prevalence of AL was 11.7%, and patients with diabetes had a higher prevalence of AL than those without (p = 0.045). In univariate analysis, we identified diabetes, HbA1c level, and hand-sewn anastomosis as risk factors for AL significantly (p = 0.033, 0.009, and 0.011, respectively), but we also found previous smoking history, chronic hepatic disease, and supracarinal tumor location also showed tendencies to be risk factors (p = 0.057, 0.055, and 0.064, respectively). Multivariate logistic regression analysis indicated that chronic hepatic disease (p = 0.048), increased HbA1c level (p = 0.011), and hand-sewn anastomosis (p = 0.021) were independent risk factors for AL.

Conclusions

Preoperative HbA1c level was significantly associated with the development of AL after cervical esophagogastric anastomosis. We recommend preoperative HbA1c screening for all patients scheduled to undergo esophagectomy.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Akihiko Okamura, Masayuki Watanabe, Yu Imamura, Satoshi Kamiya, Kotaro Yamashita, Takanori Kurogochi & Shinji Mine

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  1. Akihiko Okamura
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  2. Masayuki Watanabe
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  3. Yu Imamura
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  4. Satoshi Kamiya
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  6. Takanori Kurogochi
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Correspondence to Masayuki Watanabe.

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Okamura, A., Watanabe, M., Imamura, Y. et al. Preoperative Glycosylated Hemoglobin Levels Predict Anastomotic Leak After Esophagectomy with Cervical Esophagogastric Anastomosis. World J Surg 41, 200–207 (2017). https://doi.org/10.1007/s00268-016-3763-z

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