Risk factors and prediction model of anastomotic leakage after McKeown esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DAI Lei , REN Zixue , ZHANG Anqing ,  ZHANG Rongxin

Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Cancer Hospital, Hefei, 230031, P.R.China;

Corresponding?author：

ZHANG Rongxin, Email: zrx13855219010@126.com

Keywords：

Esophageal cancer; anastomotic leakage; risk factors; prediction model

DOI：

10.7507/1007-4848.202004017

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the risk factors for anastomotic leakage after McKeown esophagectomy, and to establish a risk prediction model for early clinical intervention.Methods We selected 469 patients including 379 males and 90 females, with a median age of 67 (42-91) years, who underwent McKeown esophagectomy in our department from 2018 to 2019. The clinical data of the patients were analyzed.Results Among the 469 patients, 7.0% (33/469) patients had anastomotic leakage after McKeown esophagectomy. Logistic analysis showed that the risk factors for anastomotic leakage were operation time >4.5 h, postoperative low albumin and postoperative hypoxemia (P<0.05). A prognostic nomogram model was established based on these factors with the area under the receiver operator characteristic curve of 0.769 (95%CI 0.677-0.861), indicating a good predictive value.Conclusion Operation time >4.5 h, postoperative low albumin and postoperative hypoxemia are the independent risk factors for anastomotic leakage after McKeown esophagectomy. Through the nomogram prediction model, early detection and intervention can be achieved, and the hospital stay can be shortened.

Citation： DAI Lei, REN Zixue, ZHANG Anqing, ZHANG Rongxin. Risk factors and prediction model of anastomotic leakage after McKeown esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1436-1440. doi: 10.7507/1007-4848.202004017 Copy

1.	陳萬青, 李賀, 孫可欣, 等. 2014年中國惡性腫瘤發病和死亡分析. 中華腫瘤雜志, 2018, 40(1): 5-13.
2.	中國抗癌協會食管癌專業委員會. 食管癌規范化診治指南. 北京, 中國協和醫科大學出版社, 2011. 24-61.
3.	劉俊宏, 施貴冬, 付茂勇, 等. 食管癌術后食管胃吻合口狹窄的危險因素及對策. 中華胸部外科電子雜志, 2018, 5(3): 159-163.
4.	van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg, 2020, 271(1): 128-133.
5.	許哲, 張鑫, 許順. 胸外科術后嚴重并發癥的臨床特點及診治—單中心10年結果. 中國胸心血管外科臨床雜志, 2019, 26(9): 858-864.
6.	代磊, 張安慶, 張榮新, 等. 177例胸段食管癌淋巴結轉移規律研究. 中國胸心血管外科臨床雜志, 2017, 24(2): 122-126.
7.	Klevebro F, Elliott JA, Slaman A, et al. Cardiorespiratory comorbidity and postoperative complications following esophagectomy: a European multicenter cohort study. Ann Surg Oncol, 2019, 26(9): 2864-2873.
8.	陳傳貴, 于振濤, 金慶文, 等. 食管癌術后吻合口瘺的臨床特點及危險因素分析. 中華外科雜志, 2015, 53(7): 518-521.
9.	Sun HB, Li Y, Liu XB, et al. Embedded three-layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer. Ann Thorac Surg, 2016, 101(3): 1131-1138.
10.	Aoyama T, Kazama K, Atsumi Y, et al. Clinical influence of anastomotic leakage on esophageal cancer survival and recurrence. Anticancer Res, 2020, 40(1): 443-449.
11.	趙延江, 黃虹儒, 蘭朗, 等. 機械吻合與手工吻合在食管癌切除術食管胃吻合中的應用效果比較. 中國臨床新醫學, 2017, 10(6): 555-557.
12.	Li J, Wang B, Liang T, et al. Pre-embedded cervical circular stapled anastomosis in esophagectomy. Thorac Cancer, 2020, 11(3): 723-727.
13.	Guo W, Ma X, Yang S, et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc, 2016, 30(9): 3873-3881.
14.	徐寶珠. 胸腔鏡食管癌切除術與開胸手術在食管癌治療中的療效比較. 臨床研究, 2020, 28(1): 42-43.
15.	Turrentine FE, Denlinger CE, Simpson VB, et al. Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg, 2015, 220(2): 195-206.
16.	劉娟, 張霞. 食管癌患者圍術期營養不良與并發癥的相關性及危險因素分析. 中國醫藥導報, 2018, 15(35): 102-105.
17.	Hayashi M, Kawakubo H, Mayanagi S, et al. A low surgical Apgar score is a predictor of anastomotic leakage after transthoracic esophagectomy, but not a prognostic factor. Esophagus, 2019, 16(4): 386-394.
18.	Sun ZW, Du H, Li JR, et al. Constructing a risk prediction model for anastomotic leakage after esophageal cancer resection. J Int Med Res, 2020, 48(4): 300060519896726.

1. 陳萬青, 李賀, 孫可欣, 等. 2014年中國惡性腫瘤發病和死亡分析. 中華腫瘤雜志, 2018, 40(1): 5-13.
2. 中國抗癌協會食管癌專業委員會. 食管癌規范化診治指南. 北京, 中國協和醫科大學出版社, 2011. 24-61.
3. 劉俊宏, 施貴冬, 付茂勇, 等. 食管癌術后食管胃吻合口狹窄的危險因素及對策. 中華胸部外科電子雜志, 2018, 5(3): 159-163.
4. van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg, 2020, 271(1): 128-133.
5. 許哲, 張鑫, 許順. 胸外科術后嚴重并發癥的臨床特點及診治—單中心10年結果. 中國胸心血管外科臨床雜志, 2019, 26(9): 858-864.
6. 代磊, 張安慶, 張榮新, 等. 177例胸段食管癌淋巴結轉移規律研究. 中國胸心血管外科臨床雜志, 2017, 24(2): 122-126.
7. Klevebro F, Elliott JA, Slaman A, et al. Cardiorespiratory comorbidity and postoperative complications following esophagectomy: a European multicenter cohort study. Ann Surg Oncol, 2019, 26(9): 2864-2873.
8. 陳傳貴, 于振濤, 金慶文, 等. 食管癌術后吻合口瘺的臨床特點及危險因素分析. 中華外科雜志, 2015, 53(7): 518-521.
9. Sun HB, Li Y, Liu XB, et al. Embedded three-layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer. Ann Thorac Surg, 2016, 101(3): 1131-1138.
10. Aoyama T, Kazama K, Atsumi Y, et al. Clinical influence of anastomotic leakage on esophageal cancer survival and recurrence. Anticancer Res, 2020, 40(1): 443-449.
11. 趙延江, 黃虹儒, 蘭朗, 等. 機械吻合與手工吻合在食管癌切除術食管胃吻合中的應用效果比較. 中國臨床新醫學, 2017, 10(6): 555-557.
12. Li J, Wang B, Liang T, et al. Pre-embedded cervical circular stapled anastomosis in esophagectomy. Thorac Cancer, 2020, 11(3): 723-727.
13. Guo W, Ma X, Yang S, et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc, 2016, 30(9): 3873-3881.
14. 徐寶珠. 胸腔鏡食管癌切除術與開胸手術在食管癌治療中的療效比較. 臨床研究, 2020, 28(1): 42-43.
15. Turrentine FE, Denlinger CE, Simpson VB, et al. Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg, 2015, 220(2): 195-206.
16. 劉娟, 張霞. 食管癌患者圍術期營養不良與并發癥的相關性及危險因素分析. 中國醫藥導報, 2018, 15(35): 102-105.
17. Hayashi M, Kawakubo H, Mayanagi S, et al. A low surgical Apgar score is a predictor of anastomotic leakage after transthoracic esophagectomy, but not a prognostic factor. Esophagus, 2019, 16(4): 386-394.
18. Sun ZW, Du H, Li JR, et al. Constructing a risk prediction model for anastomotic leakage after esophageal cancer resection. J Int Med Res, 2020, 48(4): 300060519896726.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors and prediction model of anastomotic leakage after McKeown esophagectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content