Association of anastomotic leakage with long-term oncologic outcomes of patients with esophagogastric junction cancer

Table 1 Clinicopathologic characteristics of the study population

	All (n = 122)
Sex
Male/female	96 (78.7%)/26 (21.3%)
Age, median (min, max)	68 (35-87)
Histology
Adenocarcinoma/squamous cell carcinoma	95 (77.9%)/27 (22.1%)
Neoadjuvant	32 (26.2%)
Adjuvant	27 (22.1%)
Approach
Transthoracic/transhiatal	47 (38.5%)/75 (61.5%)
Reconstruction site
Cervical/Intrathoracic	22 (18.0%)/100 (82.0%)
Subtotal esophagectomy	41 (33.6%)
Total gastrectomy	37 (30.3%)
Splenectomy	16 (13.1%)
Operating time (min); median (range)	299 (114-775)
Amount of bleeding (mL); median (range)	180 (10-4858)
Tumor epicenter
Esophageal side/gastric side	52 (42.6%)/70 (57.4%)
Distance from the EGJ to the tumor center (mm)	1.5 (-201-20)
Esophageal invasion (mm)	11.5 (0-55)
Tumor diameter (mm)	32 (6-100)
Pathologic stage of esophageal cancer
Stage I/stage II/stage III/stage IV	44 (36.1%)/24 (19.7%)/38 (31.2%)/16 (13.1%)
Residual cancer
R0/R1	111 (91.0%)/11 (9.0%)

¹This indicates that tumor epicenter is located on gastric side. EGJ: Esophagogastric junction.

Table 2 Postoperative complications

	All grades	Grade 3/4
Overall complications	40 (32.8%)	17 (13.9%)
Pneumonia	12 (9.8%)	1 (0.8%)
Anastomotic leakage	8 (6.6%)	7 (5.7%)
Recurrent laryngeal nerve paralysis	6 (5%)	0
Wound infection	4 (3.3%)	0
Chyle leakage	3 (2.5%)	2 (1.7%)
Hemorrhage	2 (1.7%)	2 (1.7%)
Pancreatic fistula	3 (2.5%)	0
Atrial fibrillation	2 (1.7%)	0
Abdominal abscess	3 (2.5%)	1 (0.8%)
Gastric tube-bronchial fistula	1 (0.8%)	1 (0.8%)
Others	9 (7.4%)	3 (2.5%)

Table 3 Predictors for overall survival on univariate and multivariate analyses

	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Male (vs female)	0.71 (0.34–1.49)	0.365
Age (per 1 year increase)	1.06 (1.02-1.09)	0.004	1.05 (1.01-1.08)	0.014
SCC (vs AC)	2.06 (1.02-4.16)	0.045	1.20 (0.50-2.87)	0.674
Neoadjuvant + (vs neoadjuvant-)	2.22 (1.11-4.44)	0.025	1.61 (0.72-3.58)	0.244
Adjuvant + (vs adjuvant-)	1.76 (0.86-3.62)	0.122
Transthoracic approach (vs transhiatal approach)	1.64 (0.83-3.22)	0.148
pStage III/IV (vs pStage I/II)	9.55 (3.68-24.76)	< 0.001	7.14 (2.67-19.13)	< 0.001
R1 (vs R0)	2.62 (1.08-6.35)	0.033	1.79 (0.69-4.68)	0.232
Anastomotic leakage	3.07 (1.07-8.80)	0.037	3.59 (1.11-11.58)	0.032
Postoperative pneumonia	1.68 (0.59-4.78)	0.332

P: Pathologic; SCC: Squamous cell carcinoma; AC: Adenocarcinoma; R0: No residual tumor; R1: Microscopic residual tumor; HR: Hazard ratio.

Table 4 Patterns of recurrence

	All (n = 122)	Anastomotic leakage		P value
		Yes (n = 8)	No (n = 114)
Hematogenous	19 (15.6%)	4 (50%)	15 (13.2%)	0.005
Lymphatic	23 (18.9%)	3 (37.5%)	20 (17.5%)	0.163
Peritoneal	7 (5.7%)	2 (25%)	5 (4.4%)	0.015
Local	4 (3.3%)	2 (25%)	2 (1.8%)	< 0.001