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Meta-Analysis
. 2025 Jun 11;56(1):132.
doi: 10.1007/s12029-025-01213-z.

Prehabilitation Reduces Occurrence of Anastomotic Leaks After Esophagectomy-A Retrospective Cohort Analysis and Meta-analysis

Alissa Jell  1 , Alexandra Dusi  1 , Marcus Feith  1 , Jeannine Bachmann  1 , Dirk Wilhelm  1 , Marc Martignoni  1 , Ekin Ihsan Demir  1 , Helmut Friess  2 , Stephan Schorn  1   3
Affiliations
Meta-Analysis

Prehabilitation Reduces Occurrence of Anastomotic Leaks After Esophagectomy-A Retrospective Cohort Analysis and Meta-analysis

Alissa Jell et al. J Gastrointest Cancer. .

Abstract

Background: Esophageal anastomotic leaks (EAL) after esophagectomy strongly increase postoperative mortality and morbidity. Identifying, addressing, and improving risk factors are pivotal. In this article, we conducted a systematic review with meta-analysis, comparing findings with our 13-year experience in a German high-volume esophageal surgery center.

Methods: Databases of Pubmed, Scopus, and Cochrane were systematically screened for publications prior to 2025, and all patients undergoing esophageal resection surgery from 2010 to 2022 were analyzed for EAL occurrence, incorporating the review data into our analysis.

Results: Among 14,163 studies screened, 202 were included, with 123 studies providing sufficient information on risk factors' impact on EAL. Our patient register revealed 144 out of 787 with EAL. Cardiopulmonary factors such as hypertension (RR 1.44; p = 0.0004), coronary artery disease (RR 1.28; p = 0.0004), heart insufficiency (RR 1.56; p = 0.05), peripheral artery disease (RR 1.65; p = 0.0009), pulmonary disease (RR 1.5; p = 0.01), COPD (RR 1.39; p = 0.13), renal insufficiency (RR 1.61; p = 0.03), diabetes mellitus (RR 1.51; p < 0.00001), obesity (BMI > 25; RR 1.31; p = 0.009; BMI > 30; RR 1.49; p = 0.006), smoking (former smoker: RR 1.54; p < 0.0001; active smoker: RR 1.25; p < 0.0001), and frequent alcohol intake (RR 1.7; p = 0.003) were all associated with an increased risk of EAL following esophagectomy. We show that preoperative management targeting these risk factors result in a significant reduction of EAL.

Conclusion: Our extensive review underscores the critical role of cardiovascular, pulmonary, and renal conditions in EAL development, emphasizing the importance of prehabilitation to mitigate risks associated with EAL after esophagectomy.

Keywords: Anastomotic insufficiency; Anastomotic leakage; Esophagectomy; Meta-analysis; Prehabilitation; Systematic review.

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Conflict of interest statement

Declarations. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA flowchart
Fig. 2
Fig. 2
Impact of demographic parameters on the development of EAL
Fig. 3
Fig. 3
Impact of cardiovascular risk factors on the development of EAL
Fig. 4
Fig. 4
Impact of pulmonary and renal comorbidities on the development of EAL
Fig. 5
Fig. 5
Impact of cancer specification on the development of EAL
Fig. 6
Fig. 6
Impact of neoadjuvant treatment on the development of EAL
Fig. 7
Fig. 7
Analysis of publication bias
See this image and copyright information in PMC

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