Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer

Abstract

Background/aims: The purpose of this study was to investigate the incidence of esophagojejunal anastomotic leakage (EJAL) after total gastrectomy.

Methodology: Four hundred and four consecutive gastrectomy cases were reviewed to determine the incidence of esophagojejunal anastomotic leakage.

Results: EJAL developed in 33 patients (8.2%). The rate of leakage was found to be significantly related to the preoperative lymphocyte count and serum albumin level. Cases of para-aortic lymph node dissection (D4) had a significantly higher rate (16.1%) of EJAL than in conventional lymph node dissection (D2,3: 5.3%). The left upper abdominal evisceration group demonstrated a significantly higher EJAL rate (20.0%) than the cases without combined resection (4.8%).

Conclusion: Aggressive surgery for advanced gastric cancer increases the risk of esophagojejunal anastomotic leakage. When aggressive surgery is necessary for curative purposes, meticulous preoperative, intraoperative and postoperative care are indispensable.