SSAT - Anastomotic-Related Morbidity Predicts Long-Term Survival After Resection for Gastric and Esophageal Cancer

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Anastomotic-Related Morbidity Predicts Long-Term Survival After Resection for Gastric and Esophageal Cancer
Andreas Andreou^*, Johann Pratschke, Matthias Biebl

Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany

Background: Several studies have reported on the association between perioperative morbidity and reduced long-term survivals following resection for colorectal or pancreatic cancer. However, the impact of anastomotic complications on the survival of patients undergoing resection for gastric or esophageal cancer remains unclear.
Methods: Clinicopathological data of patients who underwent resection for gastric or esophageal cancer between 2005 and 2012 were assessed and predictors for overall (OS) and disease-free survival (DFS) were identified. In addition, we evaluated the impact of anastomotic leak on long-term survivals.
Results: Gastric or esophageal cancer was resected in 471 patients. The primary tumor was located in the stomach and esophagus in 53% and 47% of the cases, respectively. Anastomotic leak (AL) was diagnosed in 41 (8.7%) patients. The AL-rate was significantly higher following resection for esophageal cancer compared to the resection for gastric cancer (12.9 vs. 5.3%, P=0.001). Postoperative mortality was not significantly associated with the occurrence of AL (4% without AL vs. 7% with AL, P=0.2). After a median follow-up time of 35 months, the median OS and DFS were 101 and 93 months, respectively. Diminished OS was associated with ASA physical status (P<0.0001), AL (P=0.001), advanced UICC stage (P<0.0001), and poorly differentiated carcinoma (G3) (P=0.040) in the multivariate analysis. Factors associated with reduced DFS in the multivariate analysis included AL (P=0.037), advanced UICC stage (P<0.0001), poorly differentiated carcinoma (G3) (P=0.044), und lymphangiosis carcinomatosa (P=0.004).
Conclusion: AL following resection for gastric and esophageal cancer has a negative prognostic impact on long-term survivals, independently from tumor stage and biology. This finding emphasizes that careful planning and precise performance of oncologic resection are essential to reduce the anastomotic leak rate and improve long-term oncologic outcomes.

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