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：

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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.	陈万青, 李贺, 孙可欣, 等. 2014年中国恶性肿瘤发病和死亡分析. 中华肿瘤杂志, 2018, 40(1): 5-13.
2.	中国抗癌协会食管癌专业委员会. 食管癌规范化诊治指南. 北京, 中国协和医科大学出版社, 2011. 24-61.
3.	刘俊宏, 施贵冬, 付茂勇, 等. 食管癌术后食管胃吻合口狭窄的危险因素及对策. 中华胸部外科电子杂志, 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.	许哲, 张鑫, 许顺. 胸外科术后严重并发症的临床特点及诊治—单中心10年结果. 中国胸心血管外科临床杂志, 2019, 26(9): 858-864.
6.	代磊, 张安庆, 张荣新, 等. 177例胸段食管癌淋巴结转移规律研究. 中国胸心血管外科临床杂志, 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.	陈传贵, 于振涛, 金庆文, 等. 食管癌术后吻合口瘘的临床特点及危险因素分析. 中华外科杂志, 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.	赵延江, 黄虹儒, 兰朗, 等. 机械吻合与手工吻合在食管癌切除术食管胃吻合中的应用效果比较. 中国临床新医学, 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.	徐宝珠. 胸腔镜食管癌切除术与开胸手术在食管癌治疗中的疗效比较. 临床研究, 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.	刘娟, 张霞. 食管癌患者围术期营养不良与并发症的相关性及危险因素分析. 中国医药导报, 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. 陈万青, 李贺, 孙可欣, 等. 2014年中国恶性肿瘤发病和死亡分析. 中华肿瘤杂志, 2018, 40(1): 5-13.
2. 中国抗癌协会食管癌专业委员会. 食管癌规范化诊治指南. 北京, 中国协和医科大学出版社, 2011. 24-61.
3. 刘俊宏, 施贵冬, 付茂勇, 等. 食管癌术后食管胃吻合口狭窄的危险因素及对策. 中华胸部外科电子杂志, 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. 许哲, 张鑫, 许顺. 胸外科术后严重并发症的临床特点及诊治—单中心10年结果. 中国胸心血管外科临床杂志, 2019, 26(9): 858-864.
6. 代磊, 张安庆, 张荣新, 等. 177例胸段食管癌淋巴结转移规律研究. 中国胸心血管外科临床杂志, 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. 陈传贵, 于振涛, 金庆文, 等. 食管癌术后吻合口瘘的临床特点及危险因素分析. 中华外科杂志, 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. 赵延江, 黄虹儒, 兰朗, 等. 机械吻合与手工吻合在食管癌切除术食管胃吻合中的应用效果比较. 中国临床新医学, 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. 徐宝珠. 胸腔镜食管癌切除术与开胸手术在食管癌治疗中的疗效比较. 临床研究, 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. 刘娟, 张霞. 食管癌患者围术期营养不良与并发症的相关性及危险因素分析. 中国医药导报, 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

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