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Esophageal anastomotic leak does not affect ability to receive adjuvant treatment.

Abstract：

BACKGROUND:Esophageal anastomotic leak is associated with high morbidity and mortality and potentially lethal if not recognized promptly and treated aggressively. While many studies have attempted to delineate the surgical techniques associated with lower rates of anastomotic leak, few have attempted to determine its long term effects on adjuvant therapy and patient quality of life. METHODS:We reviewed our prospective 350 patient esophageal-gastric database and found 194 esophageal anastomoses performed from 1994 to 2013. Leaks were classified based on timing, severity, and location. We then compared their postoperative courses of adjuvant treatment, morbidity/mortality, and quality of life measured by Karnofsky performance status and EORTC score. Statistical correlations were calculated with χ(2) , T-test, Kaplain-Meier, ANOVA, and Cox Regression analyses as appropriate. RESULTS:Of 194 patients receiving esophageal anastomoses for cancer, 35 (18%) developed clinically diagnosed anastomotic leak 27 from esophagogastric and 8 from esophagojejunal. These groups were similar in preoperative history, preoperative staging, and type of tumor. Type of operation and variations in operative technique did not significantly affect leak rate. Patients with a leak were more likely to require intraoperative transfusion (47.1% vs. 24.1%, P = 0.013). As expected, they had a greater prevalence of perioperative complications to include pneumonia (38.6% vs. 16.3%, P = 0.001), pulmonary embolus (11.3% vs. 4.3%, P = 0.043), ileus (11.4% vs. 1.6%, P = 0.006%), empyema (11.4% vs. 0%, P > 0.001), and catheter related blood stream infections (8.6% vs. 0%, P = 0.001). Despite this increase in perioperative morbidity, there was no statistically significant difference in 90 day peri-operative mortality (2.8% vs. 2.3%) with similar ability to receive adjuvant therapy (38.6% vs. 48.0%, P = 0.303), quality of life scores (93.2 vs. 93.1, P = 0.9), and survival at 12 months (93% vs. 94%, P = 0.3). CONCLUSION:Anastomotic leak after oncologic resection does not preclude adjuvant therapy and, when managed appropriately, does not affect long term performance status or survival.

journal_name

J Surg Oncol

journal_title

Journal of surgical oncology

authors

Martin RC,Farmer RW,St Hill RC,McMasters KM,Scoggins CR

doi

10.1002/jso.23902

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

855-61

issue

eissn

0022-4790

issn

1096-9098

journal_volume

111

pub_type

临床试验,杂志文章

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Esophageal anastomotic leak does not affect ability to receive adjuvant treatment.