Anastomotic leakage (AL) is one of the major complications of gastro-esophageal anastomosis after esophagectomy, which causes short-term morbidity and mortality, as well as poor long-term survival. The aim of this study was to investigate factors which were associated with AL after esophagectomy in order to determine the optimal surgical technique to reduce AL. Methods A total of 128 patients with thoracic esophageal cancer underwent subtotal esophagectomy followed by retrosternal reconstruction with gastric conduit with cervical anastomosis using circular staple in our institute from January 2008 and January 2020. The relationship between AL and surgical procedures as well as clinicopathological characteristics of the patients were retrospectively investigated. In addition, we divided the patients into 65 cases in former period (December 2015) and 63 cases in later period (January 2016-) to compare the incidence of AL. Results AL was observed in 12 cases (9.4%) of the 128 patients. The incidence of AL decreased from 16.9% (11/65) in former period to 1.6% (1/63) in later period (p = 0.004). In comparison between the cases with and without AL (12 cases vs 116cases), statistically significant difference was seen in BMI (average ± SD, 24.2 ± 4.7 vs 21.6 ± 3.1; p = 0.02), anastomotic site (posterior wall/greater curvature, 11/1 vs 54/62; p = 0.004), and level of anastomosis (above/below superior border of manubrium of sternum, 12/0 vs 33/83; p < 0.001). While multivariate analysis revealed that former or later period were the only independent factors relevant to AL (p = 0.01). Conclusion Surgical procedure which avoid excessive pressure on the gastric tube from the surrounding structures, such as sternum, may take an important role in reduction of AL after esophagectomy. However, multiple factors, such as nutritional status and obesity, also influence risk of anastomotic leakage.

中文翻译：

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157 减少食管切除术后吻合口漏的外科手术

吻合口漏（AL）是食管切除术后胃食管吻合口的主要并发症之一，导致短期发病率和死亡率，以及长期生存率低。本研究的目的是调查食管切除术后与 AL 相关的因素，以确定减少 AL 的最佳手术技术。方法 2008 年 1 月至 2020 年 1 月在我院收治的 128 例胸段食管癌患者行食管次全切除术后胸骨后重建胃导管颈椎吻合器环形吻合器。对患者进行了回顾性调查。此外，我们将患者分为前期（2015年12月）65例和后期（2016年1月-）63例，比较AL的发生率。结果 128例患者中有12例（9.4%）出现AL。AL的发生率从前期的16.9%（11/65）下降到后期的1.6%（1/63）（p=0.004）。在有和没有 AL 的病例之间（12 例 vs 116 例），BMI（平均 ± SD，24.2 ± 4.7 vs 21.6 ± 3.1；p = 0.02）、吻合口（后壁/大弯， 11/1 vs 54/62；p = 0.004）和吻合水平（胸骨柄上缘上方/下方，12/0 vs 33/83；p < 0.001）。虽然多变量分析显示，前期或后期是与 AL 相关的唯一独立因素（p = 0.01）。结论 避免胸骨等周围结构对胃管施加过大压力的外科手术可能对减少食管切除术后的胃食管反流病具有重要作用。然而，营养状况和肥胖等多种因素也会影响吻合口漏的风险。