Risk Factors Of Anastomotic Leakage After Esophageal Cancer Surgery

Background and purpose:Anastomotic fistula after esophageal cancer surgery is one of the most serious and common postoperative complications after thoracic surgery.It is also one of the most common causes of death after thoracic surgery.This paper analyzes the risk factors of esophagogastrostomy fistula after perioperative esophageal cancer resection,and discusses the methods to prevent and reduce anastomotic fistula after esophageal cancer resectionMethod:The clinical data of patients who underwent radical resection of esophageal cancer from January 2017 to October 2019 in thoracic surgery department of Shandong provincial hospital were retrospectively analyzed.Through clinical observation and literature review,the possible related factors with the occurrence of esophagogastrostomy fistula were selected,including the age,gender,intraoperative hemorrhage,anesthesia time,BMI(body height and weight index),preoperative albumin level,anastomosis site,pathological stage,differentiation,arteriosclerosis,past history,postoperative pulmonary infection,ASA stage and other indicators.The risk factors were screened out through single factor analysis,and then the independent risk factors of esophagogastrostomy fistula were screened out through Logistic regression analysis.Result:Of the 300 patients in this study,the total postoperative anastomotic leakage rate was 3.67%(1 1/300).Among the indexes,age,sex,intraoperative hemorrhage,BMI(body height and weight index),pathological stage,differentiation,main artery sclerosis,past history,ASA stage and other indexes were compared between the anastomotic fistula group and the anastomotic fistula group,and the difference was not statistically significant(P>0.05).The average albumin level before operation was 40.6(±2)g/l in anastomotic fistula group and 42.5(±4.5)g/l in non-anastomotic fistula group,the difference was statistically significant(p<0.05).The average anesthesia time was 5.4(±1.7)hours in anastomotic fistula group and 4.0(±0.9)hours in non-anastomotic fistula group,the difference was statistically significant(p<0.05).The incidence of cervical anastomotic leakage in all patients was 30.43%(7/23),right thoracic top anastomotic leakage was 3.91%(2/51),supraarch anastomotic leakage was 0.61%(1/165),and infraarch anastomotic leakage was 1.64%(1/61),the difference was statistically significant(p<0.05).The incidence rate of anastomotic fistula in patients with postoperative pulmonary infection was 13.72%(7/51),and that in patients without postoperative pulmonary infection was 1.61%(4/245),with statistically significant difference(P<0.05)Logistic regression analysis showed that the anastomosis site(P=0.001,OR=0.058),operation time(P=0.021,OR=0.505),postoperative pulmonary infection(P=0.011,OR=8.441)and preoperative albumin level(P=0.031,OR=1.315)were independent risk factors for postoperative anastomotic fistula.Conclusion:1.Operative anastomosis site,operative time,postoperative pulmonary infection and preoperative albumin level are independent risk factors for esophagogastrostomy fistula.2.Choosing intrathoracic anastomosis for the middle and lower thoracic esophageal cancer and actively preventing postoperative pulmonary infection may reduce the incidence of postoperative anastomotic leakage.