Bin Li1,2, Jiaqing Xiang1,2, Yawei Zhang1,2, Hong Hu1,2, Yihua Sun1,2, Haiquan Chen3,4. 1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. 2. Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China. 3. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. hqchen1@yahoo.com. 4. Department of Oncology, Shanghai Medical College, Fudan University, 270#Dong'an Rd, Shanghai, 20032, China. hqchen1@yahoo.com.
Abstract
OBJECTIVE: We aimed to clarify the association between anastomotic leak and leak-associated mortality to assist decision-making and reduce hospital mortality. BACKGROUND: Anastomotic leak is a common complication after esophagectomy, but the nature of its relationship to leak-associated mortality has not been established. METHODS: A retrospective review of all esophagogastric anastomotic leaks that had occurred between 2008 and 2012 at our institution (n = 246) was performed. Risk factors for leak-associated mortality were determined using a multivariate logistic regression analysis. RESULTS: Of the 246 patients with anastomotic leaks, 14 (5.7 %) died. Leak-associated mortality rates were similar regardless of anastomosis location (cervical vs. thoracic anastomosis), surgical approaches (retrosternal vs. prevertebral reconstruction route) and anastomotic techniques (hand-sewn vs. mechanical anastomosis). When a leak occurred, risk factors for leak-associated mortality as determined by multivariate logistic analysis included patient age >60 years (P = 0.029) and the occurrence of the leak within 1 week of surgery (P = 0.039). When disease worsened after treatment, leak-associated mortality was more frequent in patients requiring reintubation (25.6 vs. 1.4 %, P < 0.001). Fatal bleeding and sepsis were the most common causes of leak-associated mortality. CONCLUSION: In patients with anastomotic leaks, patient age >60 years and the occurrence of the leak within 1 week of surgery were risk factors for leak-associated mortality. Increased efforts to reduce the incidence of early anastomotic leaks within 1 week after surgery and prevent the need for reintubation are important for improving patient prognosis.
OBJECTIVE: We aimed to clarify the association between anastomotic leak and leak-associated mortality to assist decision-making and reduce hospital mortality. BACKGROUND:Anastomotic leak is a common complication after esophagectomy, but the nature of its relationship to leak-associated mortality has not been established. METHODS: A retrospective review of all esophagogastric anastomotic leaks that had occurred between 2008 and 2012 at our institution (n = 246) was performed. Risk factors for leak-associated mortality were determined using a multivariate logistic regression analysis. RESULTS: Of the 246 patients with anastomotic leaks, 14 (5.7 %) died. Leak-associated mortality rates were similar regardless of anastomosis location (cervical vs. thoracic anastomosis), surgical approaches (retrosternal vs. prevertebral reconstruction route) and anastomotic techniques (hand-sewn vs. mechanical anastomosis). When a leak occurred, risk factors for leak-associated mortality as determined by multivariate logistic analysis included patient age >60 years (P = 0.029) and the occurrence of the leak within 1 week of surgery (P = 0.039). When disease worsened after treatment, leak-associated mortality was more frequent in patients requiring reintubation (25.6 vs. 1.4 %, P < 0.001). Fatal bleeding and sepsis were the most common causes of leak-associated mortality. CONCLUSION: In patients with anastomotic leaks, patient age >60 years and the occurrence of the leak within 1 week of surgery were risk factors for leak-associated mortality. Increased efforts to reduce the incidence of early anastomotic leaks within 1 week after surgery and prevent the need for reintubation are important for improving patient prognosis.
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