An analysis of risk factors for benign anastomotic stenosis after McKeown esophagectomy for esophageal cancer

Objective To investigate the risk factors of benign anastomotic stenosis after neck anastomosis in patients with esophageal cancer undergoing three-incision esophagectomy (Mckeown surgery). Methods The data of patients who underwent Mckeown esophagectomy with tubular stomach for esophageal cancer in Shanghai Chest Hospital from September 2016 to August 2017 were selected and retrospectively analyzed. Patients with benign anastomotic stenosis after surgery and enduring 3 times or more dilations after operation were selected as the stenosis group. Patients with less than 3 times dilations or without dilatation were selected as the control group. In both group, each patient’s basic condition, ASA score, surgical method, reconstruction route, location of tubular stomach, R0 resection of tumor , anastomotic leakage were used to analyze the risk factors for anastomotic stenosis. Results Among the 271 patients, 9.6% of them had 3 times dilations or more. By univariate analyses, the factors including elder age(>70) , preoperative neoadjuvant therapy, hand suture anastomosis, retrostrernal reconstruction route, anastomotic leakage , whether achieving R0 resection or not are all related to severe anastomotic stenosis(P<0.05). However by multivariate logistic regression analyses, the condition of anastomotic leakage(OR=5.541, 95% CI: 2.110-14.549, P=0.001)and retro-strernal reconstruction route(OR=6.736, 95% CI : 1.623-27.965, P=0.009)are two independent risk factors for severe anastomotic stenosis. Conclusions Anastomotic leakage and retrostrernal reconstruction route are two independent risk factors for anastomotic stenosis after cervical anastomosis in esophageal cancer. Key words: Esophageal cancer; Three-incision esophagectomy; Anastomotic stenosis; Anastomotic leakage; Retrostrernal reconstruction route