Post–operative cervical anastomotic leak in esophageal cancer– Experience of a regional cancer centre in South India.

Ajeet Tiwari; Ramachandra C; Srinivas C; Krishnamurthy S; Sushruta M.S.; Ravi Koppad

Volume : VII, Issue : II, February - 2018

Post–operative cervical anastomotic leak in esophageal cancer– Experience of a regional cancer centre in South India.

Ajeet Tiwari, Ramachandra C, Srinivas C, Krishnamurthy S, Sushruta M. S. , Ravi Koppad

Abstract :

Introduction: Esophageal surgeries have always been considered challenging both in terms of surgical expertise and post operative complications and also its management. Cervical anastomosis between remaining cervical stump and stomach conduit has always been prone for leak given the precarious blood supply of the conduit at the apex.

Aims and Objectives: To identify factors affecting cervical anastomotic leak and its association with postoperative stricture.

Materials and Methods: All 98 patients who underwent esophageal cancer surgery with cervical anastomosis at our institute in the year 2016 were included in the study. Anastomotic leak rates were identified and perioperative factors affecting anastomotic leak were evaluated.

Results: Of the 12 patients (12.24%) who had cervical anastomotic leak, 10 had Clavien Dindo Grade II and 2 had Grade IIIa leak requiring endoscopic procedure. Leak was significantly associated with Increased operative time (p=0.027), more number of lymph node extraction (p=0.014), increased number of days of ICU stay (p=0.046), stapler conduit (p=0.008), stapler anastomosis (p=0.007), administration of parenteral nutrition (p=0.018), recurrent laryngeal nerve palsy (p=0.007) and postoperative LRTI (p=0.0001). Anastomotic leak however was not significantly associated with stricture formation upon resolution (p=0.650). Handsewn anastomosis were associated with increased rates of post operative stricture formation than stapler anastomosis however it was not statistically significant (p=0.422).

Conclusion: Significant morbidity is associated with anastomotic leaks in esophageal cancer surgeries. Identification of critical risk factors and refinement of operative techniques can reduce the morbidity caused by this complication.