Overall Survival Following Anastomotic Leakage After Surgery for Carcinoma of the Esophagus and Gastroesophageal Junction: A Systematic Review

Abstract

The effect of anastomotic leakage, in patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction, on overall survival (OS) is a debated and controversial topic. The aim of this systematic review was to clarify the impact of anastomotic leakage on long-term survival of patients with esophageal cancer undergoing esophagectomy. A systematic literature review was carried out from 2000 to 2022. We chose articles reporting data from patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction. Data regarding 1-, 3-and 5-year OS were analyzed. Twenty studies met the inclusion criteria, yielding a total of 9,279 patients. Analyzing data from selected studies, anastomotic leakage was found to be associated with decreased OS in 5,456 cases while in the remaining 3,823 it had no impact on long term survival (p<0.05). However, this result did not emerge from the other studies considered in the systematic review. Anastomotic leakage is a severe postoperative complication, which seems to have an impact on overall survival. However, the topic remains debated and not supported by all case series included in this systematic review.Esophageal cancer is the seventh most common cancer in the world and the sixth in mortality overall (544,000 deaths) in 2020 (1). Approximately 70% of cases occur in men, and there is a 2-to 3-fold difference in incidence and mortality rates between the sexes worldwide (1). Despite improvements in secondary and tertiary prevention, it still remains among the cancers with the highest death rate, with a 5-year survival rate of approximately 20% (2).Two are the main histological subtypes of esophageal cancer: esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) (3). In addition, ESCC accounts for >85% of all esophageal cancer cases and it represents the most frequent histology in Asia and the incidence of EAC (4), especially in Western populations, has increased significantly. The increased incidence of EAC appears to be due to a birth cohort effect (for example, generational changes in prevalence of obesity), and this trend is expected to remain stable in highincome countries until 2030 (5).Surgery remains the treatment of choice for prolonged survival, the cornerstone of any potential cure and it is integrated in multimodal therapy, especially for advanced disease (6). Esophagectomy is a technically demanding procedure that is still associated with major complications and except in specialized centers, mortality and morbidity 1423