DOES GASTROESOPHAGEAL ANASTOMOTIC LEAK CHANGE OVER TIME? A DECADE WORTH OF EXPERIENCE
Haytham H. Alabbas*1,2, Keouna Pather1, Erin M. Mobley1, Ziad Awad1
1surgery, University of Florida Health Jacksonville Physicians Inc, Jacksonville, FL; 2King Faisal Specialist Hospital and Research Centre - Jeddah, Jeddah, Makkah, Saudi Arabia
INTRODUCTION
Esophageal resection is a complex procedure that is associated with significant postoperative complications. The aim of the study is to assess the occurrences of anastomotic leak following minimally invasive Ivor-Lewis esophagectomy (MILE) at 30- and 90-days postoperatively, and to determine if the rate of anastomotic leak has changed over time.
METHODS
This retrospective study examined consecutive adult patients who underwent MILE from September 18, 2013 to November 30, 2022. Patient data collected from the electronic medical record included demographics (i.e., age, sex ), risk factors and comorbidities (i.e., body mass index, smoking status, alcohol and drug use, diabetes mellitus, hypertension, prior abdominal surgery), intraoperative parameters (i.e., operative time, blood loss, urine output, intravenous fluid), and postoperative course (i.e., anastomotic leak, length of stay, reoperations, mortality, readmissions). Descriptive statistics characterized the sample; chi-square and Mann Whitney U-test were used to examine associations with anastomotic leak for nominal and non-nominal variables, respectively.
RESULTS
A total of 244 patients underwent MILE (cancer 96%, non-cancer 4%) during the study period. Mean operative time was 412 minutes (206-866 minutes). Mean length of hospital stay was 11.5 days (2-63 days). Within 30 days following MILE, the rate of reoperation in the same admission was 7% (N=18), readmissions was 9% (N=23), and mortality 3% (N=7).
The rate of anastomotic leak was 7% (N=16). Of those, two patients underwent reoperation in the index admission and six patients had readmission within 30-days. Those who experienced anastomotic leak (N=16) were more likely to have longer length of stay by four days (p<0.004) and more likely to be readmitted (p<0.002).
There was no mortality experienced within 30-days postoperatively. There were 2 deaths within 90-days postoperatively among those who experienced leak versus 13 in the non-leak group, however this was not statistically significant. There was also no statistically significant difference between the leak and no leak group in terms of body mass index, operative time, and blood loss.
Over period of ten years, we noticed no statistically significant difference in the rate of anastomotic leak, even after conducting sensitivity analyses by clustering patients into groups of 25-50 to delve into trend changes.
CONCLUSION
We found that the rate of gastroesophageal anastomotic leak was low overall, and the incidence did not change over time despite advances in operative techniques, technology, and perioperative care. Future investigations should leverage multi-institutional randomized controlled trials to delve into trends in anastomotic leak.
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