Clinical study of esophageal anastomic leakage

Objective To investigate the causes,risk factors and treatment of esphageal anastomotic leakage.Methods The clinical data of 317 patients underwent esophagectomy for esophageal carcinoma were analyzed retrospectively.Eleven non-repetitive and characteristic clinical factors were investigated.The risk factors potentially affecting the anastomotic leakage were analyzed by single factor analysis.Logistic regression analysis was used to study which variables were main risk factor of influencing the anastomotic leakage after esophagectomy.We evaluated the patients' clinical characteristics and diatrizoate contrast findings.Results Postoperative anastomic leakage occurred in 17 cases(5.36％).Four cases died,the fatality rate was 23.53％.The analysis disclosed the following 4 risk factors affecting the anastomotic leakage:cervical anastomosis through the substernal approach (OR =8.990),preoperative serum albuminous level less than 35 g / L (OR =7.542),history of preoperative radiotherapy (OR =7.422),and respiratory illness (OR =7.410).Conclusions The ratio of anastomic leakage through substernal pathway after esophagectomy for esophageal carcinoma was higher than that through esophageal bed path way.Preoperative radiotherapy,hypoproteinemia and history of respiratory disease are risk factors for anastomic leakage.Cervical anastomotic leakage based on conservative therapy,the prognosis is good,intra thoracic anastomotic leakage be treated mainly with the second surgery.Neoplasty combined with simultaneously stent placement achieve better prognosis. Key words: Esophageal cancer;  Anastomotic leakage;  Treatment;  Prevention