Risk Factors Of Cervical Anastomotic Leakage After McKeown Minimally Invasive Esophagectomy

Objective:This study aimed to identify the risk factors of cervical anastomotic leakage?CAL?after McKeown minimally invasive esophagectomy?MIE?and determine the cutoff value in order to predict the accuracy of the technique as early as possible.Methods:A total of 129 patients with esophageal cancer who underwent McKeown MIE at the Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University,between January 2018 and June 2019 were retrospectively reviewed.Quantitative data between Group CAL?patients with CAL?and Group NCAL?patients without CAL?was tested by Student's t-test or Mann–Whitney U-test,as appropriate.P values of<0.05 was defined as statistically significant.Qualitative data was tested by Chi-square test or its continuous correction.Fisher's exact test was used if any expected value was less than 1.Multivariate logistic regression analysis was used to identify the risk factors for CAL,including odds ratios,confidence intervals and P value.Receiver operating characteristic?ROC curve?analysis was used to predict the accuracy for each quantitative data variable and determine the cutoff value.Results:There were statistically significant differences between Group CAL and Groups NCAL in FEV₁?P=0.031?,neoadjuvant chemotherapy?P=0.001?,intraoperative minimum PaCO₂ in arterial blood gas?ABG??P=0.002?and hospital stays?P<0.001?.In multivariate logistic regression,FEV₁?OR=0.440,95%CI=0.196-0.987,P=0.047?,neoadjuvant chemotherapy?OR=4.425,95%CI=1.639-11.948,P=0.003?,and intraoperative minimum PaCO₂ in ABG?OR=1.14,95%CI=1.052-1.236,P<0.001?were identified to be three risk factors of CAL.The ROC curve analysis showed that FEV₁<2.18L?AUC:0.630,P=0.029?and intraoperative minimum PaCO₂>45.5mm Hg in ABG?AUC:0.686,P=0.002?demonstrated good accuracy.Conclusions:FEV₁,neoadjuvant chemotherapy and intraoperative minimum PaCO₂ in ABG were considered as risk factors of CAL after McKeown MIE for esophageal cancer.Preoperative FEV₁<2.18L and intraoperative minimum PaCO₂>45.5mm Hg in ABG showed good accuracy in predicting CAL.