Drug Use, Preoperative Anemia May Increase Risk of Anastomotic Leak after Minimally Invasive Esophagectomy

Cantrell MC, Celso B, Mobley EM, et al. The Anastomotic Leak Triad: Preoperative Patient Characteristics, Intraoperative Risk Factors, and Postoperative Outcomes. J Gastrointest Surg. 2024.

Esophageal cancer is an aggressive malignancy associated with overall mortality risk of 20%. Minimally invasive esophagectomy (MIE) is an accepted approach for surgical management of patients with potentially curable disease.

The procedure, however, is complex with a very steep learning curve; published data show that operative mortality is 23%, and anastomotic leak is a major contributor to postoperative morbidity. According to data cited in the article, this complication occurs in 15%–34% of patients.

The objective of this study was to determine risk factors for anastomotic leak. A cohort of 251 patients cared for over a 10-year interval in a single institution was analyzed. Anastomotic leak occurred in 6% of patients.

After statistical analysis using logistic regression, prior or current drug use and preoperative anemia were identified as risk factors for anastomotic leak. Anastomotic leak did not influence rates of tumor recurrence or overall mortality.

The authors recommended that treatment of drug use and correction of anemia should be part of the preoperative optimization protocol. Because of the low anastomotic leak rate in this series, the sample size is small (16 patients), making identification of all risk factors difficult. Cantrell and colleagues emphasized that additional research is needed to identify modifiable risk factors for anastomotic leak.