Analysis Of Risk Factors Of Cervical Anastomotic Leakage After Minimally Invasive Esophagectomy

Objective:To explore and analyze the risk factors of cervical anastomotic leakage after minimally invasive esophageal cancer surgery,in order to provide theoretical basis to prevent and reduce the occurrence of cervical anastomotic leakage.Methods:310 patients who underwent thoracoscopic esophagectomy or thoracolaparoscopic-esophagectomy in the Department of Thoracic Surgery,Subei People’s Hospital of Yangzhou University were enrolled from January 2015 to December 2017,and their clinical data were collected and retrospectively analyzed.We selected the following factors that might be associated with the occurrence of cervical anastomotic leakage after minimally invasive esophagectomy by consulting the correlatively domestic and foreign literature and the experience observation in the clinical treatment were taken into consideration as well.There were 27 related factors from 4 aspects of general information of patients,operation-related information,post-operative information and tumor-related information.The t test or rank sum test were used to process the measurement data.Pearson chi-square test,Fisher’s exact test or continuous correction test were used to process the count data.The univariate analysis was used to select the risk factors of the cervical anastomotic leakage while logistic regression analysis was used to analyze the risk factors of single factor analysis and select the independent risk factors.Results:Of the 310 cases enrolled,60 patients who underwent thoracoscopic esophagectomy or thoracolaparoscopic-esophagectomy had cervical anastomotic leakage.The rate of cervical anastomotic leakage was 19.35%.55 patients of cervical anastomotic leakage were cured after treated with conservative treatment.5 patients were discharged when the conditions of cervical anastomotic leakage were stabilized with nasal jejunal nutrition tube.And upper gastrointestinal contrast examination of these patients after discharge suggested that anastomotic stoma healed.No one died or underwent second operation during the perioperative period.The univariate analysis showed that the five influencing factors of a smoking history of≥400 cigarette-years,diabetes,intraoperative hypotension,postoperative pulmonary infection and postoperative fiberoptic bronchoscopy were closely related to the occurrence of cervical anastomotic leakage(P<0.05).Multivariate logistic regression analysis showed that smoking history of>400 cigarette-years(OR=2.111,P=0.023),diabetes(OR=4.346,P=0.002),intraoperative hypotension(OR=2.219,P=0.014)and postoperative pulmonary infection(OR=5.618,P=0.000)were independent risk factors for the occurrence of cervical anastomotic leakage after minimally invasive esophagectomy.Conclusion:There is still a certain incidence of cervical anastomotic leakage after minimally invasive esophagectomy,but most of them can be cured after treated with conservative treatment,and the mortality rate is very low.Long-term smoking history(≥400 cigarette-years),diabetes,intraoperative hypotension,and postoperative pulmonary infection are independent risk factors for the occurrence of cervical anastomotic leakage after minimally invasive esophagectomy.While preventing and reducing the occurrence of cervical anastomotic leakage,timely detection and early intervention can effectively prevent or reduce the occurrence of serious complications caused by cervical anastomotic leakage entering the mediastinum and thoracic cavity,which is particularly important for the rapid healing of cervical anastomotic leakage.