Clinical Analysis Of Anastomosis Fistula After Esophagectomy For Esophageal Carcinoma

Objective The purpose of this study was to investigate the causes, risk factors, prevention and treatment of anastomotic fistula after esophagectomy for esophageal carcinoma.Methods The clinical data of 317 patients underwent esophagectomy for esophageal carcinoma from August 2005 to August 2009 was analyzed retrospectively. 11 non-repetitive and characteristic clinical factors, including gender, age, history of diabetes, preoperative serum albuminous level, anastomotic mode, anastomotic site, operation time, preoperative history of radiotherapy, cervical anastomotic pathway, history of respiratory diseases and hypertension, were investigated. The risk factors potentially affecting the anastomotic fistula were analyzed by single factor analysis. Logistic regression analysis was used to study which variables were main risk factor of influencing the anastomotic fistula after esophagectomy. We evaluated the patients' clinical characteristics, preoperative CT, endoscopy, diatrizoate contrast findings.Results 17 cases out of 317 patients underwent esophagectomy for esophageal carcinoma had anastomotic fistula (5.36%).1 case out of 17 patients with anastomotic fistula died, the mortality rate was 23.53%. The analysis disclosed the following 4 risk factors affecting the anastomotic fistula:cervical anastomosis through the substernal approach (OR=8.990), preoperative serum albuminous level less than 35g/L (OR=7.542), history of preoperative radiotherapy (OR=7.422), and respiratory illness (OR=7.410). Anastomotic fistula can be diagnosed via clinical symptoms, such as fever, chest pain, cough, wound swelling and infection, methylene blue or diatrizoate contrast. CT or endoscopy may be needed in a small fistula.9 (52.9%)cases out of 17 patients with anastomotic fistula accept secondary surgery. The neoplasty was applicable to the early small fistula with light chest infection, whereas the late fistula with heavy chest infection needed the neoplasty combined with stent placement(4 cases), cervical esophagostomy with gastrostomy or jejunostomy(3 cases), thoracotomy debridement or drainage(1 cases). Neoplasty combined with stent placement in 4 cases, cervical esophagostomy with gastrostomy or jejunostomy in 3 cases, thoracotomy debridement or drainage in 1 cases, neoplasty only in 1 cases.7 cases were cured,2 cases were dead, the mortality rate of secondary surgery rate of 22.2%.7(41.2%)cases out of 17 patients with anastomotic fistula underwent conservative treatment (include stent placement only),6 cases of cervical anastomotic fistula only were cured and 1 case of stent placement was dead. The mortality rate of conservative treatment was 14.3%.1 case gave up treatment and died.Conclusion Reconstruction of Esophagus through esophageal bed after esophagectomy for esophageal carcinoma was apt to occur anastomotic fistula more often than that through substernal pathway. Compared with stapling anastomosis, manual anastomosis was prone to anastomotic fistula. The risk factors for anastomotic fistula are preoperative radiotherapy, hypoproteinemia and history of respiratory disease. Cervical anastomotic fistula can be cured via conservative treatment, although thoracic anastomotic fistula was treated maily with the second surgery. Neoplasty combined with simultaneously stent placement seems to achieve better prognosis.