Risk factors and prediction model of perioperative esophagogastric anastomotic leakage after esophageal cancer surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NIE Hongxin ^1,2 , YANG Sihao ³ , LIU Honggang ³ , CAI Gaoping ² , CHAO Dong ¹ ,  MENG Hui ³

1. Department of Cardiothoracic Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, 730000, P. R. China;
2. School of the First Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
3. Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, 519100, Guangdong, P. R. China;

Corresponding author：

MENG Hui, Email: mhgl2008@163.com

Keywords：

Esophageal cancer; anastomotic leakage; risk factors; prediction model

DOI：

10.7507/1007-4848.202102002

Video：

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Objective To analyze the risk factors for esophagogastric anastomotic leakage (EGAL) after esophageal cancer surgery, and to establish a risk prediction model for early prevention and treatment.Methods Clinical data of patients undergoing esophagectomy in our hospital from January 2013 to October 2020 were retrospectively analyzed. The independent risk factors for postoperative EGAL were analyzed by univariate and multivariate logistic regression analyses, and a clinical nomogram prediction model was established. According to whether EGAL occurred after operation, the patients were divided into an anastomotic fistula group and a non-anastomotic fistula group.Results A total of 303 patiens were enrolled, including 267 males and 36 females with a mean age of 62.30±7.36 years. The incidence rate of postoperative EGAL was 15.2% (46/303). The multivariate logistic regression analysis showed that high blood pressure, chronic bronchitis, peptic ulcer, operation way, the number of lymph node dissected, anastomotic way, the number of intraoperative chest drainage tube, tumor location, no-supplementing albumin in the first three days after operation, postoperative pulmonary infection, postoperative use of bronchoscope were the independent risk factors for EGAL after esophageal cancer surgery (P<0.05). A prognostic nomogram model was established based on these factors with the area under the receiver operating characteristic curve of 0.954 (95%CI 0.924-0.975), indicating a high predictive value.Conclusion The clinical prediction model based on 11 perioperative risk factors in the study has a good evaluation efficacy and can promote the early detection, diagnosis and treatment of EGAL.

Citation： NIE Hongxin, YANG Sihao, LIU Honggang, CAI Gaoping, CHAO Dong, MENG Hui. Risk factors and prediction model of perioperative esophagogastric anastomotic leakage after esophageal cancer surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(4): 586-592. doi: 10.7507/1007-4848.202102002 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	毛友生, 高树庚, 王群, 等. 中国食管癌临床流行特征及外科治疗概况大数据分析. 中华肿瘤杂志, 2020, 42(3): 228-233.
3.	Moon SW, Kim JJ, Cho DG, et al. Early detection of complications: Anastomotic leakage. J Thorac Dis, 2019, 11(Suppl 5): S805-S811.
4.	Hoek VT, Edomskis PP, Menon AG, et al. Arterial calcification is a risk factor for anastomotic leakage after esophagectomy: A systematic review and meta-analysis. Eur J Surg Oncol, 2020, 46(11): 1975-1988.
5.	Luo J, Zhuo ZG, Zhu YK, et al. Fixed in the neck or pushed back into the thorax?—Impact of cervical anastomosis position on anastomosis healing. J Thorac Dis, 2020, 12(5): 2153-2160.
6.	Liu YJ, Fan J, He HH, et al. Anastomotic leakage after intrathoracic versus cervical oesophagogastric anastomosis for oesophageal carcinoma in Chinese population: A retrospective cohort study. BMJ Open, 2018, 8(9): e021025.
7.	钟宏源. 微创食管切除术后吻合口瘘的危险因素分析. 福建医科大学, 2015. 1-40.
8.	Nilsson M. The combination of respiratory comorbidity and neoadjuvant chemoradiotherapy may double the risk of anastomotic leaks after esophagectomy: Do we know enough to tailor neoadjuvant therapies, or take other preemptive measures in high-risk patients? Ann Surg Oncol, 2019, 26(9): 2660-2661.
9.	Goense L, Meziani J, Ruurda JP, et al. Impact of postoperative complications on outcomes after oesophagectomy for cancer. Br J Surg, 2019, 106(1): 111-119.
10.	Wang J, Zhang B, Meng J, et al. Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China. Exp Ther Med, 2017, 14(3): 2584-2594.
11.	Gooszen JAH, Goense L, Gisbertz SS, et al. Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer. Br J Surg, 2018, 105(5): 552-560.
12.	任卫东. 微创食管癌切除术后颈部吻合口瘘的危险因素分析. 扬州大学, 2019. 1-47.
13.	Aoyama T, Atsumi Y, Hara K, et al. Risk factors for postoperative anastomosis leak after esophagectomy for esophageal cancer. In Vivo, 2020, 34(2): 857-862.
14.	赵珩, 高文. 胸外科手术学. 北京: 人民卫生出版社, 2017. 723-725.
15.	程飞, 何玉华, 刘术尧, 等. 纵隔置管引流在胃食管胸内吻合术中的应用价值探讨. 中华全科医学, 2015, 13(7): 1063-1064, 1084.
16.	Huang C, Yao H, Huang Q, et al. A novel nomogram to predict the risk of anastomotic leakage in patients after oesophagectomy. BMC Surg, 2020, 20(1): 64.
17.	Tibshirani R. The lasso method for variable selection in the Cox model. Stat Med, 1997, 16(4): 385-395.
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. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 毛友生, 高树庚, 王群, 等. 中国食管癌临床流行特征及外科治疗概况大数据分析. 中华肿瘤杂志, 2020, 42(3): 228-233.
3. Moon SW, Kim JJ, Cho DG, et al. Early detection of complications: Anastomotic leakage. J Thorac Dis, 2019, 11(Suppl 5): S805-S811.
4. Hoek VT, Edomskis PP, Menon AG, et al. Arterial calcification is a risk factor for anastomotic leakage after esophagectomy: A systematic review and meta-analysis. Eur J Surg Oncol, 2020, 46(11): 1975-1988.
5. Luo J, Zhuo ZG, Zhu YK, et al. Fixed in the neck or pushed back into the thorax?—Impact of cervical anastomosis position on anastomosis healing. J Thorac Dis, 2020, 12(5): 2153-2160.
6. Liu YJ, Fan J, He HH, et al. Anastomotic leakage after intrathoracic versus cervical oesophagogastric anastomosis for oesophageal carcinoma in Chinese population: A retrospective cohort study. BMJ Open, 2018, 8(9): e021025.
7. 钟宏源. 微创食管切除术后吻合口瘘的危险因素分析. 福建医科大学, 2015. 1-40.
8. Nilsson M. The combination of respiratory comorbidity and neoadjuvant chemoradiotherapy may double the risk of anastomotic leaks after esophagectomy: Do we know enough to tailor neoadjuvant therapies, or take other preemptive measures in high-risk patients? Ann Surg Oncol, 2019, 26(9): 2660-2661.
9. Goense L, Meziani J, Ruurda JP, et al. Impact of postoperative complications on outcomes after oesophagectomy for cancer. Br J Surg, 2019, 106(1): 111-119.
10. Wang J, Zhang B, Meng J, et al. Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China. Exp Ther Med, 2017, 14(3): 2584-2594.
11. Gooszen JAH, Goense L, Gisbertz SS, et al. Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer. Br J Surg, 2018, 105(5): 552-560.
12. 任卫东. 微创食管癌切除术后颈部吻合口瘘的危险因素分析. 扬州大学, 2019. 1-47.
13. Aoyama T, Atsumi Y, Hara K, et al. Risk factors for postoperative anastomosis leak after esophagectomy for esophageal cancer. In Vivo, 2020, 34(2): 857-862.
14. 赵珩, 高文. 胸外科手术学. 北京: 人民卫生出版社, 2017. 723-725.
15. 程飞, 何玉华, 刘术尧, 等. 纵隔置管引流在胃食管胸内吻合术中的应用价值探讨. 中华全科医学, 2015, 13(7): 1063-1064, 1084.
16. Huang C, Yao H, Huang Q, et al. A novel nomogram to predict the risk of anastomotic leakage in patients after oesophagectomy. BMC Surg, 2020, 20(1): 64.
17. Tibshirani R. The lasso method for variable selection in the Cox model. Stat Med, 1997, 16(4): 385-395.
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 perioperative esophagogastric anastomotic leakage after esophageal cancer surgery

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