Prevalence and outcome of esophagogastric anastomotic leak after esophagectomy in a UK regional cancer network

• Published in: Diseases of the esophagus Vol. 23; no. 2; pp. 112 - 116
• Main Authors: Escofet, X., Manjunath, A., Twine, C., Havard, T. J., Clark, G. W., Lewis, W. G.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-02-2010
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; anastomosis; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - mortality; Body Mass Index; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - surgery; Chemotherapy, Adjuvant - statistics & numerical data; esophageal neoplasms; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; esophagectomy; Esophagectomy - adverse effects; Esophagectomy - mortality; Esophagoplasty - adverse effects; Esophagoplasty - mortality; Female; Follow-Up Studies; Gastroplasty - adverse effects; Gastroplasty - mortality; General Surgery - statistics & numerical data; Hospital Mortality; Humans; Male; Middle Aged; Neoadjuvant Therapy - statistics & numerical data; Postoperative Complications - epidemiology; Prevalence; prognosis; Prospective Studies; Radiotherapy, Adjuvant - statistics & numerical data; Reoperation - statistics & numerical data; Surgical Stapling - statistics & numerical data; Survival Rate; Suture Techniques - statistics & numerical data; Treatment Outcome; United Kingdom - epidemiology
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2009.00995.x

SUMMARY
The aim of this study was to determine the contemporary prevalence, outcome, and survival after esophagogastric anastomotic leakage (EGAL) following esophagectomy by a regional upper gastrointestinal cancer network and to investigate etiological factors. Two hundred forty consecutive patients underwent esophagectomy over a 10‐year period (median age 61 [31–79] years, 147 transthoracic and 93 transhiatal esophagectomy, 105 neoadjuvant chemotherapy, 49 chemoradiotherapy). The primary outcome measures were the development of EGAL and survival. Twenty patients developed EGAL (8.3%, 15 managed conservatively, 5 reoperation). Overall operative mortality was 2% (5 patients in total, 1 after EGAL). Median, 1 and 2‐year survival was 22 months, 73% and 50%, in patients after EGAL, compared with 31 months, 80% and 56%, in patients who did not suffer EGAL (P= 0.314). On multivariate analysis, low body mass indices (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.11–0.79, P= 0.016), individual surgeon (HR 1.21, 95% CI 1.02–1.43, P= 0.02), and neoadjuvant chemotherapy (HR 3.28, 95% CI 1.16–9.22, P= 0.024) were significantly associated with the development of EGAL. EGAL following esophagectomy remained common, but associated mortality was less common than reported in earlier Western series and long‐term survival was unaffected.