• Anastomotic leak
• Esophageal cancer
• Esophagectomy
• Self-expanding metal stents
• Vacuum-assisted closure

• Humans
• Esophagectomy/adverse effects
• Anastomotic Leak/therapy
• Anastomotic Leak/etiology
• Salvage Therapy/methods
• Drainage/methods
• Treatment Outcome
• Nutritional Support
• Anti-Bacterial Agents/therapeutic use

• Anastomotic leakage
• Nomogram
• Nutritional status

• anastomotic leak(al)
• esophageal cancer (ec)
• minimally invasive esophagectomy (mie)
• post-esophagectomy
• vacuum assisted closure (vac)

• Esophageal cancer
• Esophagectomy
• Smoking

• Anastomotic Leak/etiology
• Anastomotic Leak/epidemiology
• Humans
• Esophagectomy/adverse effects
• Smoking/adverse effects
• Smoking/epidemiology
• Esophageal Neoplasms/surgery
• Risk Factors
• Incidence

• Anastomotic leakage
• Multispectral camera
• Venous blood flow

• Anastomotic leakage
• Endoscopic treatment
• Esophageal cancer
• Esophagectomy

• Anastomosis
• Esofaguectomía
• Gastroesophageal
• Triangular mecánica
• Triangulating mechanical

• Anastomosis, Surgical/methods
• Anastomotic Leak/surgery
• Constriction, Pathologic/surgery
• Esophageal Neoplasms/surgery
• Esophagectomy/methods
• Esophagoplasty
• Humans
• Middle Aged

• Anastomotic Leak/surgery
• Humans
• Negative-Pressure Wound Therapy/methods
• Retrospective Studies
• Treatment Failure
• Treatment Outcome
• Upper Gastrointestinal Tract

• esophageal cancer
• esophagectomy
• intrathoracic anastomotic leakage
• postoperative hospital stay
• risk factor

• Esophageal carcinoma (EC)
• Ivor Lewis esophagectomy
• minimally invasive esophagectomy
• reversal penetrating technique (RPT)

Esophagectomy is a high-risk surgical procedure with significant postoperative morbidity and mortality. This study aimed to investigate the risk factors of cervical anastomotic leakage and postoperative mortality.

In this retrospective, observational study, we recruited 1010 patients with esophageal cancer. Cox regression analysis was performed to identify factors affecting anastomotic leakage and postoperative mortality. After propensity score matching, the Kaplan–Meier curve was used to evaluate the effect of leakage on postoperative mortality.

The number of patients with cervical anastomotic leakage, in-hospital mortality, 30-day postoperative mortality, and 60-day postoperative mortality was 194 (19.2%), 13 (1.3%), 12 (1.2%), and 16 (1.6%), respectively. The total length of hospital stay and hospital stay postoperatively were 29.7 ± 21.1 and 21.3 ± 20.3 days, respectively. Diabetes, stage IV, and an upper thoracic tumor were significant risk factors for leakage. Leakage and diabetes were significant risk factors for postoperative mortality. After propensity score matching, leakage also significantly affected postoperative mortality.

Patients with tumors in the upper thoracic segment of the esophagus may be more prone to developing anastomotic leakage compared with those with tumors in the middle or lower thoracic segment. Anastomotic leakage may prolong the length of hospital stay and increase postoperative mortality.

• Esophageal cancer
• cervical anastomotic leakage
• diabetes
• esophagectomy
• hospital stay
• postoperative mortality
• upper thoracic segment

• Aged
• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/diagnosis
• Anastomotic Leak/etiology
• Anastomotic Leak/mortality
• Body Mass Index
• Diabetes Mellitus, Type 2/complications
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Female
• Humans
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Pulmonary Disease, Chronic Obstructive/complications
• Retrospective Studies
• Risk Factors

This study aimed to identify variables associated with anastomotic leakage after esophagectomy and established a tool for anastomotic leakage prediction.

Twenty-six preoperative and postoperative variables were retrospectively collected from esophageal cancer patients who were treated with radical esophagectomy from January 2018 to June 2020 in the Affiliated Hospital of Qingdao University. SPSS Version 23.0 and Empower Stats software were used for establishing a nomogram after screening relevant variables by univariate and multivariate Logistic regression analyses. The established nomogram was identified by depicting the receiver operating characteristic (ROC) curves and calibration curve, which was verified by 1,000 bootstrap resamples method.

A total of 604 eligible esophageal cancer patients were included, of which 51 (8.4%) patients had anastomotic leakage. Multivariate Logistic regression analysis showed that smoking, anastomotic location, anastomotic technique, prognostic nutritional index (PNI) and ASA score were independent risks of anastomotic leakage. The area under curve (AUC) of ROC in the established nomogram was 0.764 (95% CI, 0.69–0.83). The internal validation confirmed that the nomogram had a great discrimination ability (AUC =0.766). Depicted calibration curve demonstrated a well-fitted prediction and observation probability. In addition, the decision curve analysis concluded that the newly established nomogram is significant for clinical decision-making.

This nomogram provided the individual prediction of anastomotic leakage for esophageal cancer patients after surgery, which might benefit treatment results for patients and clinicians, as well as pre-and postoperative intervention strategy-making.

• Esophageal cancer
• anastomotic leakage
• esophagectomy
• nomogram
• prediction model

• Anastomosis
• Esofaguectomía
• Gastroesophageal
• Triangular mecánica
• Triangulating mechanical

• Anastomotic leakage
• Cervical esophagogastrostomy
• Postoperative care
• Prediction
• Risk factors
• Scoring

• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/diagnosis
• Anastomotic Leak/epidemiology
• Anastomotic Leak/etiology
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Female
• Humans
• Male
• Middle Aged
• Nomograms
• Retrospective Studies
• Risk Factors

• Medical University of Graz

• anastomotic leakage
• chylothorax
• complications
• esophagectomy
• nerve palsy

Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients.

This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in 2 weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation.

Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46 ± 84.33 min and 250.55 ± 43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02).

Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

• Anastomotic leakage
• Anastomotic stricture
• End-to-side hand-sewn anastomosis
• Esophageal cancer
• Side-to-side stapled cervical esophagogastric anastomosis

The association between the preoperative condition of the esophagus and anastomotic leakage has seldom been studied. We observed a dominant dilation of the esophagus under barium esophagography in some esophageal cancer patients. In consideration of the larger circular stapler are applied in colorectal surgery, we wonder if larger circular stapler should be applied in these patients to fit the larger esophagus. The larger size of the circular stapler also could decrease the incidence of anastomosis stricture. Thus, we made this study to explore if patients with a dilated esophagus were facing a higher risk of anastomotic leakage when applying the 25 mm circular stapler.

A retrospective review of patients undergoing gastroesophageal intrathoracic anastomosis using a 25 mm circular stapler was performed. Patients with endoscopy or barium esophagography confirmed anastomotic leakage was assigned to leakage group (LG) while the left was enrolled in no leakage group (NLG). The measurement of the diameter of the esophagus was carried out at the level of 5 centimeters away from the upper margin of the tumor on esophagography.

LG had a greater intraluminal mucosal phase diameter (IMPD) than NLG (P=0.010). The ROC curve indicated 1.79 cm as the cutoff value for IMPD. Patients with IMPD greater than 1.79 cm had a statistically significant higher rate of leakage. In the multivariate logistic regression analysis, dilated IMPD was proven to be a risk factor of 25 mm-circular-stapler anastomotic leakage.

Patients with an IMPD over 1.79 mm are facing a higher risk of intrathoracic anastomosis leakage when applying the 25 mm circular stapler. Larger circular stapler or hand-sewn would be the better choice for these patients.

• Esophagus
• anastomotic leakage
• risk factor

• Chemoradiotherapy
• Complications
• Esophageal cancer
• Risk factor
• Surgery

This study examined the association between smoking and perioperative complications of laparoscopic abdominal surgery and whether these complications were reduced with ≥ 4 weeks of preoperative smoking cessation.

A total of 555 patients who underwent gastric and colorectal cancer surgeries under general anesthesia were divided into the following groups retrospectively: 290 individuals without smoking history (NS group), 144 previous smokers (stopped smoking more than 8 weeks before surgery, PS group), and 121 current smokers (CS group) divided to two groups according to preoperative smoking cessation for < 4 (CS1, n = 76) and 4–8 weeks (CS2, n = 45).

When compared with the NS group, postoperative hospitalization duration was significantly longer in the CS1 group (p < 0.01), whereas differences between the CS2 or PS groups and NS group were not significant. The total number of postoperative complications was higher in all groups of smoking than in NS group, independent on preoperative smoking cessation; however, suture failure was significantly more frequent only in CS1 group. Although pack-years did not significantly affect complication rates in smokers, duration of smoking cessation time in PS group was a negative predictor of postoperative complications.

Providing more than 4 weeks of smoking cessation before gastrointestinal surgery can reduce the duration of hospitalization and rate of suture failure.

• Abdominal surgery
• Postoperative complications
• Smoking cessation

Anastomotic leakage is a dangerous postoperative complication of oesophageal surgery. The present study aimed to develop a simple and practical scoring system to predict the risk of anastomotic leakage after oesophageal resection.

A consecutive series of 330 patients who underwent oesophageal cancer surgery from January 2016 to January 2018 at the Shanghai Chest Hospital were included to develop a prediction model. Anastomotic leakage was evaluated using oesophagography, computed tomography, or flexible endoscopy. Least absolute shrinkage and selection operator regression based on a generalized linear model was used to select variables for the anastomotic leakage risk model while avoiding overfitting. Multivariable logistic regression analysis was applied to build forest plots and a prediction model. The concordance index or the area under the curve was used to judge the discrimination, and calibration plots verified the consistency. Internal validation of the model was conducted, and the clinical usefulness and threshold screening of the model were evaluated by decision curve analysis.

The factors included in the predictive nomogram included Sex, diabetes history, anastomotic type, reconstruction route, smoking history, CRP level and presence of cardiac arrhythmia. The model displayed a discrimination performance with a concordance index of 0.690 (95% confidence interval: 0.620–0.760) and good calibration. A concordance index value of 0.664 was maintained during the internal validation. The calibration curve showed good agreement between the actual observations and the predicted results.

The present prediction model, which requires only seven variables and includes Sex, diabetes history, anastomotic type, reconstruction route, smoking history, CRP level and presence of cardiac arrhythmia, may be useful for predicting anastomotic leakage in patients after oesophagectomy.

• Anastomotic leakage
• Nomogram
• Oesophagus operation
• Predictors

• complication
• esophageal cancer
• esophagectomy
• risk factor

• complication
• enteral nutrition
• esophagectomy

• anastomotic leak
• contrast study
• esophageal cancer
• esophagectomy

• delayed oral feeding
• esophageal anastomotic leak
• transhiatal esophagectomy

• Achalasia
• Barium upper GI
• Esophagram
• Fundoplication

• Anastomotic leakage
• endoluminal vacuum therapy (EVT)
• esophageal cancer
• esophagectomy
• health related quality of life (HRQOL)

• Anastomotic leakage
• Esophageal cancer
• Esophagogastric anastomosis
• Linear stapled anastomosis

• Esophageal cancer
• anastomotic leak
• prediction

• Anastomotic leak
• Esophagogastric anastomosis
• Indocyanine green fluorescein imaging

• anastomotic leakage
• diabetes mellitus
• esophagectomy
• meta-analysis

• Anastomotic leakage
• comorbidities
• esophageal reconstruction
• subcutaneous route

• Aid
• Benefit
• Effect
• Intervention
• Level
• Mean
• Prevention of relapse
• Support

• Age Factors
• Anastomosis, Surgical
• Anastomotic Leak/mortality
• China/epidemiology
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Female
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Retrospective Studies
• Risk Factors

• Anastomotic leak
• Barium
• Esophagectomy
• Esophagus

• K08 HL114725 NHLBI NIH HHS

• Esophagectomy
• amylase
• anastomotic leak

Anastomotic leak is one of the main causes of morbidity following esophageal resection for carcinoma of the esophagus and gastroesophageal junction. We compared hand sewn and stapled cervical esophagogastric anastomotic techniques in terms of postoperative complications.

All patients who underwent esophagectomy with cervical esophagogastric anastomosis at a single academic center from 2004 to 2014 were included in the study. Both early and late complications were analyzed.

153 patients underwent resection for carcinoma of the esophagus and gastroesophageal junction. Of these 140 patients had esophagectomy with cervical esophagogastric anastomosis. 66 patients underwent a hand sewn anastomosis and 74 patients had a side-to-side stapled anastomosis fashioned. Both groups were comparable with respect to preoperative characteristics. There was no difference in the operative blood loss and T and N stage of the disease. The overall morbidity and mortality was 32.8% and 6.4%, respectively. Overall leak rate was 17%. There was no difference in the leak rates among two groups (12 in the hand-sewn group & 12 in the Stapled stapled group; p = 0.82). The rate of anastomotic stricture was significantly higher for the hand sewn group (16.1% vs 4.3%; p = 0.03) at median follow up of 30 months.

Both hand sewn and stapled anastomotic techniques are equally effective way of performing a cervical esophagogastric anastomosis. However, patients having anastomotic leak develop anastomotic stricture more often in those having hand-sewn anastomosis compared to stapled anastomosis.

•

We analyzed & compared the outcomes of cervical esophagogastric anastomosis between hand sewn and partial side to side stapled technique.

• Carcinoma esophagus
• Cervical esophagogastric anastomosis
• Esophagectomy
• Hand sewn anastomosis
• Stapled anastomosis

• Hand sewn anastomosis
• cervical esophagogastric anastomosis (CEGA)
• end-to-end anastomosis
• esophageal squamous cell carcinoma (ESCC)
• esophagectomy