Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric and Siewert type II/III esophagogastric cancer: a retrospective analysis from a tertiary hospital.

AbstractBackground:To detect the risk factors associated with esophagojejunal anastomotic leakage (EJAL) after total gastrectomy for gastric and Siewert type II/III esophagogastric cancer and investigate the effect of laparoscopic anastomosis on EJAL.Methods:The data for 609 patients underwent Roux-en-Y esophagojejunostomy after total gastrectomy between March 2015 and March 2021 were reviewed. Univariate and multivariate analyses were performed to evaluate the risk factors. We adopted propensity score matching to compare the rate of the anastomotic leakage of the laparoscopic and open anastomosis group.Results:EJAL was observed in 48 (7.9%) of 609 patients. Univariate analysis revealed that gender, age, the number of comorbidities, postoperative serum albumin, tumor location, duration of operation were risk factors associated with EJAL. Patients who had the following factors including male, age ≥50 years, the number of comorbidities ≥2, postoperative serum albumin ＜35 g/L, tumor location was esophagogastric junction, duration of operation ≥260 min were more likely to develop EJAL than those who had not. Multivariate analysis revealed that the number of comorbidities (OR 3.214, 95% CI 1.092 – 9.463,p= 0.034) and duration of operation (OR 2.68, 95% CI 1.251 – 5.740,p= 0.011) were independent risk factors associated with EJAL. 161 patients received laparoscopic anastomosis and 448 patients received open anastomosis. The rates of anastomotic leakage in the laparoscopic and open anastomosis groups were comparable after propensity score matching (Laparoscopic 8.1% vs Open 10.6%,p= 0.565).Conclusions:More morbidities and prolonged operative duration were independently associated with EJAL after total gastrectomy for gastric and Siewert type II/III esophagogastric cancer. Laparoscopic anastomosis did not increase the risk of anastomotic leakage, compared with open anastomosis.