Analysis of Cervical Esophagogastric Anastomotic Leaks After Transhiatal Esophagectomy

Risk Factors, Presentation, and Detection

David T Cooke, Giant C. Lin, Christine L. Lau, Linda Zhang, Ming Sing Si, Julia Lee, Andrew C. Chang, Allan Pickens, Mark B. Orringer

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: Transhiatal esophagectomy with cervical esophagogastric anastomosis is a common approach in patients requiring esophagectomy. Factors for developing cervical esophagogastric anastomosis leaks (CEGAL), their presentation, and the value of a routine postoperative screening barium swallow in detecting CEGALs and other complications were analyzed. Methods: This single-institution retrospective study used medical records and an esophagectomy database to assess results in 1,133 patients who underwent transhiatal esophagectomy and a cervical esophagogastric anastomosis, 241 for benign disease and 892 for cancer, between January 1996 and December 2006. Results: Esophagectomy patients who experienced CEGALs included 127 (14.2%) with cancer and 23 (9.5%) with benign disease. Logistic regression analysis identified increasing number of preoperative comorbidities (p < 0.001), active smoking history (p = 0.044), and postoperative arrhythmia (p = 0.002) as risk factors for CEGALs, and a side-to-side stapled cervical esophagogastric anastomosis compared with a manually sewn one as protective (p < 0.001). For cancer patients, higher pathologic stage disease (p = 0.050) was a risk factor for CEGALs. For patients with benign disease, a higher number of prior esophagogastric operations (p = 0.007) is a risk factor for CEGALs. Of the 90.7% of CEGALs that occurred on or before postoperative day 10, cervical wound drainage (63.3%) was the most common presenting symptom. Screening barium swallow identified postoperative complications and influenced outcome in 39 patients (3.8%). Conclusions: Higher number of preoperative comorbidities, advanced pathologic stage, postoperative arrhythmia, an increased number of prior esophagogastric surgeries, and active smoking history are risk factors for developing CEGAL, and a side-to-side stapled cervical esophagogastric anastomosis is protective. Screening barium swallow identifies few postoperative complications, but provides quality control.

Original languageEnglish (US)
Pages (from-to)177-185
Number of pages9
JournalAnnals of Thoracic Surgery
Volume88
Issue number1
DOIs
StatePublished - Jul 2009
Externally publishedYes

Fingerprint

Anastomotic Leak
Esophagectomy
Barium
Deglutition
Comorbidity
Cardiac Arrhythmias
Smoking
History
Neoplasms
Quality Control
Medical Records
Drainage
Retrospective Studies
Logistic Models
Regression Analysis
Databases
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Analysis of Cervical Esophagogastric Anastomotic Leaks After Transhiatal Esophagectomy : Risk Factors, Presentation, and Detection. / Cooke, David T; Lin, Giant C.; Lau, Christine L.; Zhang, Linda; Si, Ming Sing; Lee, Julia; Chang, Andrew C.; Pickens, Allan; Orringer, Mark B.

In: Annals of Thoracic Surgery, Vol. 88, No. 1, 07.2009, p. 177-185.

Research output: Contribution to journalArticle

Cooke, David T ; Lin, Giant C. ; Lau, Christine L. ; Zhang, Linda ; Si, Ming Sing ; Lee, Julia ; Chang, Andrew C. ; Pickens, Allan ; Orringer, Mark B. / Analysis of Cervical Esophagogastric Anastomotic Leaks After Transhiatal Esophagectomy : Risk Factors, Presentation, and Detection. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 1. pp. 177-185.
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T2 - Risk Factors, Presentation, and Detection

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AU - Lau, Christine L.

AU - Zhang, Linda

AU - Si, Ming Sing

AU - Lee, Julia

AU - Chang, Andrew C.

AU - Pickens, Allan

AU - Orringer, Mark B.

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AB - Background: Transhiatal esophagectomy with cervical esophagogastric anastomosis is a common approach in patients requiring esophagectomy. Factors for developing cervical esophagogastric anastomosis leaks (CEGAL), their presentation, and the value of a routine postoperative screening barium swallow in detecting CEGALs and other complications were analyzed. Methods: This single-institution retrospective study used medical records and an esophagectomy database to assess results in 1,133 patients who underwent transhiatal esophagectomy and a cervical esophagogastric anastomosis, 241 for benign disease and 892 for cancer, between January 1996 and December 2006. Results: Esophagectomy patients who experienced CEGALs included 127 (14.2%) with cancer and 23 (9.5%) with benign disease. Logistic regression analysis identified increasing number of preoperative comorbidities (p < 0.001), active smoking history (p = 0.044), and postoperative arrhythmia (p = 0.002) as risk factors for CEGALs, and a side-to-side stapled cervical esophagogastric anastomosis compared with a manually sewn one as protective (p < 0.001). For cancer patients, higher pathologic stage disease (p = 0.050) was a risk factor for CEGALs. For patients with benign disease, a higher number of prior esophagogastric operations (p = 0.007) is a risk factor for CEGALs. Of the 90.7% of CEGALs that occurred on or before postoperative day 10, cervical wound drainage (63.3%) was the most common presenting symptom. Screening barium swallow identified postoperative complications and influenced outcome in 39 patients (3.8%). Conclusions: Higher number of preoperative comorbidities, advanced pathologic stage, postoperative arrhythmia, an increased number of prior esophagogastric surgeries, and active smoking history are risk factors for developing CEGAL, and a side-to-side stapled cervical esophagogastric anastomosis is protective. Screening barium swallow identifies few postoperative complications, but provides quality control.

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