Risk factors for anastomotic leakage following McKeown esophagectomy: a single-center retrospective analysis

Abstract

The OBJECTIVE was to identify risk factors for anastomotic leakage following McKeown esophagectomy.METHODS AND MATERIALS. From January 1, 2016 to December 31, 2022, in our clinic, a total of 69 patients with stage I–III esophageal cancer were operated with McKeown esophagectomy performed in a fully open approach (thoracotomy, laparotomy, cervicotomy). The characteristics of the studied patients were evaluated according to a standardized protocol. Statistically significant factors influencing the development of anastomotic failure were determined.RESULTS. The frequency of anastomotic leakage was 13/69 (18.4 %). Mortality due to anastomotic failure occurred in 3 (23 %) patients; while in the non-failure group, there were 4 (7.1 %) fatalities. The average postoperative hospital stay was 11.57±3.71 days in the non-leakage group and increased to 25.42±8.12 days in the leakage group (p=0.001). Univariate analysis revealed that the presence of diabetes mellitus, postoperative blood transfusions, and higher than Grade III chronic kidney disease significantly influenced anastomotic integrity. These factors were selected for multiple logistic regression analysis. In multivariable logistic regression only chronic kidney disease and diabetes mellitus were confirmed as significant risk factors for anastomotic failure; Type III and IV failures occurred in 5/13 (38.5 %) patients resulting in death for three individuals (23 %).CONCLUSIONS. In univariate analysis, diabetes mellitus, chronic kidney disease and perioperative blood transfusion were recognized as statistically significant risk factors associated with anastomotic leakage following McKeown esophagectomy. Unsatisfactory outcomes occurred with leakage type III and IV.

Keywords

• esophageal cancer
• esophageal surgery
• anastomotic failure
• mckeown esophagectomy