Cancer of the esophagus: esophagogastric anastomotic leak--a retrospective study of predisposing factors

Abstract

An esophagogastric anastomotic leak, especially in the mediastinum or the chest, is a life-threatening complication of surgery for cancer of the esophagus. Of 617 patients who underwent esophageal resection and esophagogastric anastomosis between January 1980 and December 1989, 39 (6.32%) had anastomotic leakage; of these, 25 (64.10%) died. Various biologic parameters, operative techniques, and the management of leaks were analysed. Albumin concentration below 3 gm/dL (chi 2 = 3.9; P = 0.047), neoplastic permeation of the anastomotic cut margin (chi 2 = 4.7; P = 0.04), and cervical anastomosis (chi 2 = 12.32; P = 0.0004) were associated with a higher incidence of anastomotic leakage. Hemoglobin level, type of suture material used for the anastomosis, preoperative radiotherapy, and the experience of the operating surgeon under supervision were found to be statistically insignificant factors and did not influence anastomotic leakage. Mortality due to leak in the first postoperative week was 85% and was statistically significant as compared to the mortality occurring in the second postoperative week (chi 2 = 6.04; P = 0.013). Surgical or conservative management of the leak did not influence mortality (chi 2 = 1.2; P = 0.27). The salvage rates for cervical and intrathoracic anastomotic leakage were 80% and 29.4%, respectively. This difference is statistically significant (chi 2 = 29; P = 0.088).