A nomogram illustrating the probability of anastomotic leakage following cervical esophagogastrostomy

Abstract

Background Early diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult. Estimation of an individual probability could help to establish preventive and diagnostic measures. The predictive impact of epidemiological, surgery-related data and laboratory parameters on the development of anastomotic dehiscence was investigated in the immediate perioperative period. Methods Retrospective study in 412 patients with cervical esophagogastrostomy following esophagectomy. Epidemiological data, risk factors, underlying disease, pre-treatment- and surgery-related data, C-reactive protein and albumin levels pre-and post-operatively were evaluated. We applied univariable and multivariable logistic regression analysis and developed a nomogram for individual risk assessment. Results There were 345 male, 67 female patients, mean aged 61.5 years; 284 had orthotopic, 128 retrosternal gastric pull-up; 331 patients had carcinoma, 81 non-malignant disease. Mean duration of operation was 184 min; 235 patients had manual, 113 mechanical and 64 semi-mechanical suturing; 76 patients (18.5%) developed anastomotic dehiscence clinically evident at mean 11.4 days after surgery. In univariable testing young age, retrosternal conduit transposition, manual suturing, high body mass index, high ASA and high postoperative levels of C-reactive protein were predictors for anastomotic leakage. These six parameters which had yielded a p < 0.1 in the univariable analysis, were entered into a multivariable analysis and a nomogram allowing the determination of the patient’s individual risk was created. Conclusion By using the nomogram as a supportive measure in the perioperative management, the patient’s individual probability of developing an anastomotic leak could be quantified which may help to take preventive measures improving the outcome.

Systemic Inflammatory Response and the Noble and Underwood (NUn) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery

“…The low concentrations of Alb and prealbumin on POD 4-6 are identified as potential risk factors for AL. Five studies evaluated postoperative Alb in relation to AL but only Noble reported a significant association with a POD 5 cut-off < 22.5 g/L with fair performance (AUC 0.742) [14][15][16][27][28][29][30]. Our analyses identified an equally fair performance for Alb with threshold values of <24.5 on POD 2 (AUC 0.710) and <26.5 g/L on POD 4 (AUC 0.799).…”

“…Elevated CRP levels are the most commonly identified markers for post-esophagectomy complications [14][15][16][17][18][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. CRP is an acute-phase protein synthesized in the liver in response to endotoxins, and its levels commonly increase within 6 h after the onset of the inflammation.…”

Application of reversely connecting circular stapler technique in cervical esophagogastric anastomosis.

“…Due to uneven needle spacing and ligation intensity, the blood microcirculation around the anastomosis is damaged, and there is still controversy in the prevention and reduction of anastomotic leakage. A nomogram prediction model study found that manual anastomosis was a high-risk factor for increasing anastomotic leakage of cervical esophagogastrostomy [ 9 ]. Another retrospective study found that esophagogastric anastomotic leakage was 14.67% in the manual anastomosis group and 5.33% in the stapler anastomosis group [ 10 ].…”