Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy
Durmuş Ali Çetin1, Ebubekir Gündeş2, Hüseyin Çiyiltepe3, Ulaş Aday4, Orhan Uzun5, Kamuran Cumhur Değer5, Mustafa Duman5
1Clinic of Gastroenterological Surgery, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
2Clinic of Gastroenterological Surgery, Diyarbakir Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
3Clinic of Gastroenterological Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
4Clinic of Gastroenterological Surgery, Elazig Training and Research Hospital, Elazig, Turkey
5Clinic of Gastroenterological Surgery, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
Objective: Esophagojejunal anastomotic leakages, which occur in the reconstruction procedures performed after total or proximal gastrectomy, still account for one of the most significant causes of morbidity and mortality in spite of the developments seen in perioperative management and surgical techniques in gastric cancer surgery. The aim of the present study was to ascertain the risk factors for Esophagojejunal anastomotic leakages.
Material and Methods: A total of 80 patients with gastric cancer, who had total gastrectomy +D2 lymph node dissection and Esophagojejunal anastomotic between January 2013 and December 2016, were retrospectively evaluated. Patients who did not have anastomotic leakages during their clinical follow-ups were allocated to Group 1, whereas those who had anastomotic leakages were allocated to Group 2.
Results: A total of 58 (72.5%) out of 80 patients were males, whereas 22 (27.5%) were females. Mean age of the patients was 61.2 ± 11.2 years. There were no demographic differences between the groups. Postoperative recurrent fever (p= 0.001), C-reactive protein values on postoperative days 3 and 5 (p= 0.01), and neutrophil-to-lymphocyte ratio on postoperative day 5 (p= 0.022) were found to be statistically significant with regard to Esophagojejunal anastomotic leakages and other postoperative complications. The duration of operation (p= 0.032) and combined organ resection (p= 0.008) were ascertained as risk factors for Esophagojejunal anastomotic leakages.
Conclusion: Surgeons should be careful about Esophagojejunal anastomotic leakages which are significant postoperative complications seen especially in cases where the duration of operation is prolonged, and additional organ resections are performed. Recurrent fever, high C-reactive protein levels, and neutrophil-to-lymphocyte ratio may serve as warnings for complications in postoperative follow-ups.
Keywords: Anastomosis leakage, gastrectomy, risk factors
Cite this article as: Çetin DA, Gündeş E, Çiyiltepe H, Aday U, Uzun O, Değer KC, et al. A. Risk factors and laboratory markers used to predict leakage in esophagojejunal anastomotic leakage after total gastrectomy. Turk J Surg 2019; 35 (1): 6-12
Ethics committee approval was received for this study from the Ethics Committee of Kartal Koşuyolu Higher Specialty Training and Research Hospital (2017.3/2-36).
Informed consent was not received due to the retrospective nature of the study.
Concept - D.A.Ç., E.G.; Design - D.A.Ç., H.Ç., E.G.; Supervision - M.D., K.C.D.; Resource - M.D., K.C.D., O.U.; Materials - M.D., K.C.D., O.U.; Data Collection and/or Processing - D.A.Ç., H.Ç., U.A.; Analysis and/or Interpretation - D.A.Ç., E.G., U.A.; Literature Search - D.A.Ç., H.Ç., U.A.; Writing Manuscript - D.A.Ç.; Critical Reviews - M.D., K.C.D., O.U.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.