Progress of influence facors and solutions of esophagogastric anastromoic leak in the perioperative period_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 MENG Hui , WANG Zhanpeng , CAO Huihui

Department of Thoracic Surgery, Hospital of Lanzhou Army, Lanzhou, 730050, P.R.China;

Corresponding author：

MENG Hui, Email: mhgl2008@163.com

Keywords：

Anastomotic leak; periopeative period; influence factors; complications

DOI：

10.7507/1007-4848.201603001

Video：

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The risk factors of esophagogastric anastomotic leak in the perioperative period include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, vasopressor drugs use, intravenous fluid administration, blood transfusion and surgical anastomotic technique, which can be reduced with the improvement of surgeons' ability to identify the high-risk patients. This article summarizes the specific measures for these risk factors: preoperative nutritional support for 5–7 d for malnourished patients, full intestinal preparation, perioperative smoking cessation, limitation of steroids and vasopressors drug applications, avoidance of early operations (<4 weeks) following chemotherapy, and the goal-directed fluid management.

Citation： MENG Hui, WANG Zhanpeng, CAO Huihui. Progress of influence facors and solutions of esophagogastric anastromoic leak in the perioperative period. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(6): 475-479. doi: 10.7507/1007-4848.201603001 Copy

1.	Krarup PM, Nordholm-Carstensen A, Jorgensen LN, et al. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg, 2014, 259(5): 930-938.
2.	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.
3.	Price TN, Nichols FC, Harmsen WS, et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg, 2013, 95(4): 1154-1160.
4.	Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis, 2014, 10(4): 713-723.
5.	庞彬, 苏雪娟, 丁旭青. 食管重建术后吻合口瘘的防治现况. 中国肿瘤外科杂志, 2012, 4(1): 51-53.
6.	Klek S, Kulig J, Sierzega M, et al. The impact of immunostimulating nutrition on infectious complications after upper gastrointestinal surgery: a prospective, randomized, clinical trial. Ann Surg, 2008, 248(2): 212-220.
7.	孙志勇, 曹子昂, 叶清, 等. 术前运用 NRS2002 评估食管癌患者营养风险及临床结局的研究. 中国胸心血管外科临床杂志, 2015, 22(4): 323-326.
8.	Midura EF, Hanseman D, Davis BR, et al. Risk factors and consequences of anastomotic leak after colectomy: a national analysis. Dis Colon Rectum, 2015, 58(3): 333-338.
9.	Wright CD, Kucharczuk JC, O’Brien SM, et al. Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg, 2009, 137(3): 587-595.
10.	Baucom RB, Poulose BK, Herline AJ, et al. Smoking as dominant risk factor for anastomotic leak after left colon resection. Am J Surg, 2015, 210(1): 1-5.
11.	Jung KH, Kim SM, Choi MG, et al. Preoperative smoking cessation can reduce postoperative complications in gastric cancer surgery. Gastric Cancer, 2015, 18(4): 683-690.
12.	Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis, 2014, 16(5): O154-O160.
13.	Ostenfeld EB, Erichsen R, Thorlacius-Ussing O, et al. Pre-admission use of glucocorticoids and 30-day mortality following colorectal cancer surgery: a population-based Danish cohort study. Aliment Pharmacol Ther, 2014, 39(8): 843-853.
14.	Hamilton E, Ravikumar R, Bartlett D, et al. Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS). Trials, 2013, 14: 249.
15.	Waterman M, Xu W, Dinani A, et al. Preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease. Gut, 2013, 62(3): 387-394.
16.	Gronnier C, Tréchot B, Duhamel A, et al. Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study. Ann Surg, 2014, 260(5): 764-770.
17.	Kumagai K, Rouvelas I, Tsai JA, et al. Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers. Br J Surg, 2014, 101(4): 321-338.
18.	Merritt RE, Whyte RI, D’Arcy NT, et al. Morbidity and mortality after esophagectomy following neoadjuvant chemoradiation. Ann Thorac Surg, 2011, 92(6): 2034-2040.
19.	Kim JY, Correa AM, Vaporciyan AA, et al. Does the timing of esophagectomy after chemoradiation affect outcome? Ann Thorac Surg, 2012, 93(1): 207-212.
20.	Deshaies I, Malka D, Soria JC, et al. Antiangiogenic agents and late anastomotic complications. J Surg Oncol, 2010, 101(2): 180-183.
21.	Fernandez-Martos C, Brown G, Estevan R, et al. Preoperative chemo-therapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II Multicenter Trial. Oncologist, 2014, 19(10): 1042-1043.
22.	Bhangu A, Singh P, Fitzgerald JE, et al. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg, 2014, 38(9): 2247-2257.
23.	Nepogodiev D, Chapman SJ, Glasbey JC, et al. Multicentre observational cohort study of NSAIDs as risk factors for postoperative adverse events in gastrointestinal surgery. BMJ Open, 2014, 4(62): e005164.
24.	Rijcken E, Sachs L, Fuchs T, et al. Growth factors and gastrointestinal anastomotic healing. J Surg Res, 2014, 187(1): 202-210.
25.	杨洁, 韦诗友, 周英, 等. 半机械吻合与手工吻合对食管癌切除食管胃吻合口并发症发生率影响的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2014, 21(5): 663-669.
26.	Naumann DN, Bhangu A, Kelly M, et al. Stapled versus handsewn intestinal anastomosis in emergency laparotomy: a systemic review and meta-analysis. Surgery, 2015, 157(4): 609-618.
27.	Löffler T, Rossion I, Gooßen K, et al. Hand suture versus stapler for closure of loop ileostomy - a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg, 2015, 400(2): 193-205.
28.	Markides GA, Wijetunga IU, Brown SR, et al. Meta-analysis of handsewn versus stapled reversal of loop ileostomy. ANZ J Surg, 2015, 85(4): 217-224.
29.	Placer C, Enríquez-Navascués JM, Elorza G, et al. Preventing complications in colorectal anastomosis: results of a randomized controlled trial using bioabsorbable staple line reinforcement for circular stapler. Dis Colon Rectum, 2014, 57(10): 1195-1201.
30.	Kim IY, Kim BR, Kim YW. Applying reinforcing sutures to stapled colorectal anastomosis after low anterior resection for rectal cancer. Eur J Surg Oncol, 2015, 41(6): 808-809.
31.	Baek SJ, Kim J, Kwak J, et al. Can transanal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy? World J Gastroenterol, 2013, 19(32): 5309-5313.
32.	Silecchia G, Boru CE, Mouiel J, et al. The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial. Surg Endosc, 2008, 22(11): 2492-2497.
33.	周文雄, 陈彤宇, 池浩, 等. 经腔内封堵治疗食管癌术后吻合口瘘. 中国胸心血管外科临床杂志, 2015, 22(8): 795-796.
34.	Burch JM, Franciose RJ, Moore EE, et al. Single-layer continuousversus two-layer interrupted intestinal anastomosis: a prospective randomized trial. Ann Surg, 2000, 231(6): 8327.
35.	Palmisano S, Giuricin M, Makovac P, et al. Totally hand-sewn anastomosis using barbed suture device during laparoscopic gastric bypass in obese. A feasibility study and preliminary results. Int J Surg, 2014, 12(12): 1385-1389.
36.	De Blasi V, Facy O, Goergen M, et al. Barbed versus usual suture for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial. Obes Surg, 2013, 23(1): 60-63.
37.	Van’t Sant HP, Kamman A, Hop WC, et al. The influence of mechanical bowel preparation on long-term survival in patients surgically treated for colorectal cancer. Am J Surg, 2015, 210(1): 106-110.
38.	Roos D, Dijksman LM, Tijssen JG, et al. Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Br J Surg, 2013, 100(12): 1579-1588.
39.	Defazio J, Fleming ID, Shakhsheer B, et al. The opposing forces of the intestinal microbiome and the emerging pathobiome. Surg Clin North Am, 2014, 94(6): 1151-1161.
40.	Scarborough JE, Mantyh CR, Sun Z, et al. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg, 2015, 262: 331-337.
41.	Moghadamyeghaneh Z, Hanna MH, Carmichael JC, et al. Nationwide analysis of outcomes of bowel preparation in colon surgery. J Am Coll Surg, 2015, 220(5): 912-920.
42.	Hellan M, Spinoglio G, Pigazzi A, et al. The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc, 2014, 28(5): 1695-1702.
43.	Protyniak B, Dinallo AM, Boyan WP Jr, et al. Intraoperative indocyanine green fluorescence angiography-an objective evaluation of anastomotic perfusion in colorectal surgery. Am Surg, 2015, 81(6): 580-584.
44.	Futier E, Constantin JM, Petit A, et al. Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: a prospective randomized trial. Arch Surg, 2010, 145(12): 1193-1200.
45.	Zakrison T, Nascimento BA Jr, Tremblay LN, et al. Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage. World J Surg, 2007, 31(8): 1627-1634.
46.	Tabatabai A, Hashemi M, Mohajeri G, et al. Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med, 2009, 4(4): 197-200.
47.	Rohde JM, Dimcheff DE, Blumberg N, et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA, 2014, 311(13): 1317-1326.

1. Krarup PM, Nordholm-Carstensen A, Jorgensen LN, et al. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg, 2014, 259(5): 930-938.
2. 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.
3. Price TN, Nichols FC, Harmsen WS, et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg, 2013, 95(4): 1154-1160.
4. Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis, 2014, 10(4): 713-723.
5. 庞彬, 苏雪娟, 丁旭青. 食管重建术后吻合口瘘的防治现况. 中国肿瘤外科杂志, 2012, 4(1): 51-53.
6. Klek S, Kulig J, Sierzega M, et al. The impact of immunostimulating nutrition on infectious complications after upper gastrointestinal surgery: a prospective, randomized, clinical trial. Ann Surg, 2008, 248(2): 212-220.
7. 孙志勇, 曹子昂, 叶清, 等. 术前运用 NRS2002 评估食管癌患者营养风险及临床结局的研究. 中国胸心血管外科临床杂志, 2015, 22(4): 323-326.
8. Midura EF, Hanseman D, Davis BR, et al. Risk factors and consequences of anastomotic leak after colectomy: a national analysis. Dis Colon Rectum, 2015, 58(3): 333-338.
9. Wright CD, Kucharczuk JC, O’Brien SM, et al. Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg, 2009, 137(3): 587-595.
10. Baucom RB, Poulose BK, Herline AJ, et al. Smoking as dominant risk factor for anastomotic leak after left colon resection. Am J Surg, 2015, 210(1): 1-5.
11. Jung KH, Kim SM, Choi MG, et al. Preoperative smoking cessation can reduce postoperative complications in gastric cancer surgery. Gastric Cancer, 2015, 18(4): 683-690.
12. Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis, 2014, 16(5): O154-O160.
13. Ostenfeld EB, Erichsen R, Thorlacius-Ussing O, et al. Pre-admission use of glucocorticoids and 30-day mortality following colorectal cancer surgery: a population-based Danish cohort study. Aliment Pharmacol Ther, 2014, 39(8): 843-853.
14. Hamilton E, Ravikumar R, Bartlett D, et al. Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS). Trials, 2013, 14: 249.
15. Waterman M, Xu W, Dinani A, et al. Preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease. Gut, 2013, 62(3): 387-394.
16. Gronnier C, Tréchot B, Duhamel A, et al. Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study. Ann Surg, 2014, 260(5): 764-770.
17. Kumagai K, Rouvelas I, Tsai JA, et al. Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers. Br J Surg, 2014, 101(4): 321-338.
18. Merritt RE, Whyte RI, D’Arcy NT, et al. Morbidity and mortality after esophagectomy following neoadjuvant chemoradiation. Ann Thorac Surg, 2011, 92(6): 2034-2040.
19. Kim JY, Correa AM, Vaporciyan AA, et al. Does the timing of esophagectomy after chemoradiation affect outcome? Ann Thorac Surg, 2012, 93(1): 207-212.
20. Deshaies I, Malka D, Soria JC, et al. Antiangiogenic agents and late anastomotic complications. J Surg Oncol, 2010, 101(2): 180-183.
21. Fernandez-Martos C, Brown G, Estevan R, et al. Preoperative chemo-therapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II Multicenter Trial. Oncologist, 2014, 19(10): 1042-1043.
22. Bhangu A, Singh P, Fitzgerald JE, et al. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg, 2014, 38(9): 2247-2257.
23. Nepogodiev D, Chapman SJ, Glasbey JC, et al. Multicentre observational cohort study of NSAIDs as risk factors for postoperative adverse events in gastrointestinal surgery. BMJ Open, 2014, 4(62): e005164.
24. Rijcken E, Sachs L, Fuchs T, et al. Growth factors and gastrointestinal anastomotic healing. J Surg Res, 2014, 187(1): 202-210.
25. 杨洁, 韦诗友, 周英, 等. 半机械吻合与手工吻合对食管癌切除食管胃吻合口并发症发生率影响的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2014, 21(5): 663-669.
26. Naumann DN, Bhangu A, Kelly M, et al. Stapled versus handsewn intestinal anastomosis in emergency laparotomy: a systemic review and meta-analysis. Surgery, 2015, 157(4): 609-618.
27. Löffler T, Rossion I, Gooßen K, et al. Hand suture versus stapler for closure of loop ileostomy - a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg, 2015, 400(2): 193-205.
28. Markides GA, Wijetunga IU, Brown SR, et al. Meta-analysis of handsewn versus stapled reversal of loop ileostomy. ANZ J Surg, 2015, 85(4): 217-224.
29. Placer C, Enríquez-Navascués JM, Elorza G, et al. Preventing complications in colorectal anastomosis: results of a randomized controlled trial using bioabsorbable staple line reinforcement for circular stapler. Dis Colon Rectum, 2014, 57(10): 1195-1201.
30. Kim IY, Kim BR, Kim YW. Applying reinforcing sutures to stapled colorectal anastomosis after low anterior resection for rectal cancer. Eur J Surg Oncol, 2015, 41(6): 808-809.
31. Baek SJ, Kim J, Kwak J, et al. Can transanal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy? World J Gastroenterol, 2013, 19(32): 5309-5313.
32. Silecchia G, Boru CE, Mouiel J, et al. The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial. Surg Endosc, 2008, 22(11): 2492-2497.
33. 周文雄, 陈彤宇, 池浩, 等. 经腔内封堵治疗食管癌术后吻合口瘘. 中国胸心血管外科临床杂志, 2015, 22(8): 795-796.
34. Burch JM, Franciose RJ, Moore EE, et al. Single-layer continuousversus two-layer interrupted intestinal anastomosis: a prospective randomized trial. Ann Surg, 2000, 231(6): 8327.
35. Palmisano S, Giuricin M, Makovac P, et al. Totally hand-sewn anastomosis using barbed suture device during laparoscopic gastric bypass in obese. A feasibility study and preliminary results. Int J Surg, 2014, 12(12): 1385-1389.
36. De Blasi V, Facy O, Goergen M, et al. Barbed versus usual suture for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial. Obes Surg, 2013, 23(1): 60-63.
37. Van’t Sant HP, Kamman A, Hop WC, et al. The influence of mechanical bowel preparation on long-term survival in patients surgically treated for colorectal cancer. Am J Surg, 2015, 210(1): 106-110.
38. Roos D, Dijksman LM, Tijssen JG, et al. Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Br J Surg, 2013, 100(12): 1579-1588.
39. Defazio J, Fleming ID, Shakhsheer B, et al. The opposing forces of the intestinal microbiome and the emerging pathobiome. Surg Clin North Am, 2014, 94(6): 1151-1161.
40. Scarborough JE, Mantyh CR, Sun Z, et al. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg, 2015, 262: 331-337.
41. Moghadamyeghaneh Z, Hanna MH, Carmichael JC, et al. Nationwide analysis of outcomes of bowel preparation in colon surgery. J Am Coll Surg, 2015, 220(5): 912-920.
42. Hellan M, Spinoglio G, Pigazzi A, et al. The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc, 2014, 28(5): 1695-1702.
43. Protyniak B, Dinallo AM, Boyan WP Jr, et al. Intraoperative indocyanine green fluorescence angiography-an objective evaluation of anastomotic perfusion in colorectal surgery. Am Surg, 2015, 81(6): 580-584.
44. Futier E, Constantin JM, Petit A, et al. Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: a prospective randomized trial. Arch Surg, 2010, 145(12): 1193-1200.
45. Zakrison T, Nascimento BA Jr, Tremblay LN, et al. Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage. World J Surg, 2007, 31(8): 1627-1634.
46. Tabatabai A, Hashemi M, Mohajeri G, et al. Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med, 2009, 4(4): 197-200.
47. Rohde JM, Dimcheff DE, Blumberg N, et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA, 2014, 311(13): 1317-1326.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Progress of influence facors and solutions of esophagogastric anastromoic leak in the perioperative period

Abstract Full text Figures/Tables Video References Cited by

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