Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer

• DOI: 10.1016/j.ejso.2020.06.035
• Publication Date: 2020-07-09T01:13:22Z
• Authors: Renza Trapani; Stefano Rausei; Rossella Reddavid; Maurizio Degiuli; Maria Bencivenga; Mariagiulia Dal Cero; Fausto Rosa; Sergio Alfieri; Guido Alberto Tib...; Marie Sophie Alfano; Monica Gualtierotti; Giovanni Ferrari; Roberto Persiani; Alberto Biondi; Annibale Donini; Luigina Graziosi; Diego Sasia; Paolo Geretto; Jacopo Vigano; Enrico Cicuttin; Federica Galli; Paolo Strignano; Elena Mazza; Antonio Taddei; Ilenia Bartolini; Lucio Taglietti; Silvia Ruggiero; Elio Treppiedi; Vittorio Postiglione; Francesco Casella; Andrea Sansonetti; Carlo Abatini; Miriam Attalla EL...; Paolo Millo; Antonella Usai; Michela Mineccia; Alessandro Ferrero
• Keywords: Reoperation; Adult; Male; Adolescent; Respiratory Tract Diseases; Anastomotic Leak; Comorbidity; Postoperative Hemorrhage; Conservative Treatment; Comorbidities; Comorbidities; Esophago-jejunal anastomosis leakage; Gastric cancer; Minimally invasive surgery; Total gastrectomy; Young Adult; 03 medical and health sciences; Postoperative Complications; Esophagus; Ileus; 0302 clinical medicine; Minimally invasive surgery; Risk Factors; Stomach Neoplasms; Gastrectomy; Surgical Wound Dehiscence; Minimally Invasive Surgical Procedures; Humans; Endoscopy, Digestive System; Mortality; Retrospective Studies; Aged; Aged, 80 and over; Anastomosis, Surgical; Carcinoma; Middle Aged; Length of Stay; Comorbidities; Esophago-jejunal anastomosis leakage; Gastric cancer; Minimally invasive surgery; Total gastrectomy; Adolescent; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Anastomotic Leak; Carcinoma; Comorbidity; Conservative Treatment; Endoscopy, Digestive System; Esophagus; Female; Humans; Ileus; Italy; Jejunum; Length of Stay; Lymph Node Excision; Male; Middle Aged; Minimally Invasive Surgical Procedures; Mortality; Postoperative Complications; Postoperative Hemorrhage; Reoperation; Respiratory Tract Diseases; Retrospective Studies; Risk Factors; Stomach Neoplasms; Surgical Wound Dehiscence; Survival Rate; Young Adult; Gastrectomy; Esophago-jejunal anastomosis leakage; 3. Good health; Survival Rate; Jejunum; Italy; Total gastrectomy; Lymph Node Excision; Female; Gastric cancer

Many Eastern reports attempted to identify predictive variables for esophago-jejunal anastomosis leakage (EJAL) after total gastrectomy for cancer. There are no definitive answers about reliable risk factors for EJAL. This retrospective study shows the largest Western series focused on this topic.This is a multicenter retrospective study analyzing patients' datasets collected by 18 Italian referral Centres of the Italian Research Group for Gastric Cancer (GIRCG) from 2000 to 2018. The inclusion criteria were pathological diagnosis of gastric and esophageal (Siewert III) carcinoma requiring total gastrectomy. The primary end point of risk analysis was the occurrence of EJAL; secondary end points were post-operative (30-day) morbidity and mortality, length of stay (LoS), and survival.Data of 1750 patients submitted to total gastrectomy were collected. EJAL developed in 116 (6.6%) patients and represented the 26.3% of all the 441 observed post-operative surgical complications. EJAL diagnosis was followed by a reoperation in 39 (33.6%) patients and by an endoscopic/radiological procedure in 30 cases (25.9%). In 47 patients (40.5%) EJAL was managed with conservative approach. Post-operative LoS and mortality were significantly higher after EJAL occurrence (27 days versus 12 days and 8.6% versus 1.6%, respectively). At risk analysis, comorbidities (particularly, if respiratory), minimally invasive surgery, extended lymphadenectomy, and anastomotic technique resulted significant predictive factors for EJAL. EJAL did not significantly affect survival.These results were consistent with Asian experiences: the frequency of EJAL and its higher rate observed in patients with comorbidities or after minimally invasive approach were confirmed.