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A New Risk Factor for Cervical Anastomotic Leakage-Role of The Relative Gastric Length in the Surgical Treatment of Esophageal Cancer

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Abstract

Background

Blood supply is especially weak near the gastric fundus. Making the anastomosis in this area would increase the risk of anastomotic leakage (AL). In cervical anastomosis, the gastric conduit needs to travel through the thorax. Therefore, the relative length between the stomach and the thorax is an essential factor in deciding if the poorly supplied area could be removed. This study was to explore if a small relative gastric length was a risk of cervical AL. If all other conditions are equal, could intrathoracic anastomosis be a better choice?

Methods

Patients who underwent esophagectomy with a preoperative barium swallow in West China Hospital between 2014 and 2017 were included. The length of the greater curvature and the thorax were obtained from the barium esophagogram. The ratio between the length of the greater curvature and the thorax was the relative gastric length calculated from the greater curvature (RGL-G).

Results

A total of 782 patients were enrolled in the final analysis. The cervical AL group had a significantly higher ratio of patients with an RGL-G less than 1.3 (26.7% vs. 8.9%, p = 0.003). The multivariate logistic regression proved that RGL-G less than 1.3 was a risk factor for cervical anastomotic leakage (p = 0.012). Correspondingly, RGL-G less than 1.3 was not a risk factor (6.3% vs. 14.3%, p = 0.289) in the intrathoracic anastomosis group.

Conclusions

RGL-G less than 1.3 was a new risk factor for cervical AL, but it would not be a problem for intrathoracic anastomosis.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (Grant Number: 81672291, 31071210 to Y.-D. Lin).

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Author notes

  1. Peng Yao and Ying Zhang have contributed equally to this study.

Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue, Chengdu, 610041, China

    Peng Yao, Gang Li, Ze-Guo Zhuo, Zhi-Jie Xu, Gu-Ha Alai & Yi-Dan Lin

  2. Department of Thoracic Surgery, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China

    Gang Li

  3. Department of Pathology, West China Hospital, Sichuan University, Chengdu, China

    Ying Zhang

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  1. Peng Yao
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  2. Ying Zhang
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  3. Gang Li
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Correspondence to Yi-Dan Lin.

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Yao, P., Zhang, Y., Li, G. et al. A New Risk Factor for Cervical Anastomotic Leakage-Role of The Relative Gastric Length in the Surgical Treatment of Esophageal Cancer. World J Surg 46, 2235–2242 (2022). https://doi.org/10.1007/s00268-022-06579-w

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