Analysis Of Risk Factors Of Cervical Anastomotic Fistula After Esophagectomy In 787 Patients With Esophageal Cancer

Objective:Surgery is the main treatment method for esophageal cancer at present,Anastomotic fistula(AF)is the most common serious complication.This article reviewed and analyzed the detailed clinical data of patients undergoing radical resection of esophageal cancer in our hospital,concluded the relevant risk factors of AF,to provide the basis for clinical surgeons’ jobs in the perioperative management of esophageal cancer patients.Methods: We reviewed 852 patients who underwent radical resection of esophageal cancer at Shengjing Hospital of China Medical University from 2011.1 to 2021.7.The study included 787 patients and their age,sex,ASA grade,preoperative albumin,preoperative blood glucose,body mass index(BMI),operation time,operation method,anastomosis method,whether to retain mediastinal drainage tube during operation,lesion site,length of tumor,length of esophagus resection,length of tumor/length of resection,T grade of tumor,N grade of tumor,G grade of tumor,new adjuvant treatment,length of tumor resection/height,calcification of descending aorta,calcification of celiac trunk,calcification of splenic artery,and whether there is anastomotic fistula after operation.We recorded the perioperative indexes of patients in detail and analyzed the risk factors of anastomotic leakage in this research.Results: The incidence of anastomotic leakage was 8.89%(70/787)among 787 patients.The results of the univariate analysis showed that there are apparent differences between the two groups of patients with or without anastomotic leakage,including operation method(P<0.001),anastomosis method(P<0.001),retaining mediastinal drainage tube or not during operation(P<0.001),lesion site(P=0.027),T grade of tumor(P=0.017),G grade of tumor(P=0.029),new adjuvant treatment(P=0.041),calcification of descending aorta(P<0.001),calcification of celiac trunk(P<0.001),calcification of splenic artery(P=0.007).The results of the multivariate logistic binary analysis showed that there were statistical differences between the two groups of patients with or without anastomotic leakage,including operation time(OR=1.007,P=0.005),operation method(OR=2.805,P=0.020),calcification of descending aorta(OR=2.167,P=0.029),the descending aorta calcification(OR=3.499,P<0.001),and calcification of celiac trunk(OR=7.160,P<0.001).The longer operation time is the independent risk factor for anastomotic leakage after esophageal cancer surgery,and 242.5 minutes is the critical cut-off value for anastomotic leakage.Conclusion: The occurrence of anastomotic leakage after radical resection of esophageal cancer is closely related to many factors.The incidence of anastomotic can be effectively reduced,avoid kinds of serious postoperative complications,and other malignant events including leading to the death of patients with the implementation of perioperative management according to these risk factors.