The Anastomotic Leak Triad: Preoperative Patient Characteristics, Intraoperative Risk Factors, and Postoperative Outcomes.

ABSTRACT

INTRODUCTION: The aim of the study is to determine perioperative risk factors associated with anastomotic leak (AL) following Minimally Invasive Esophagectomy (MIE), and its association on cancer recurrence and overall survival. METHODS: This retrospective observational study of electronic health record data included patients who underwent MIE for esophageal cancer between September 2013 and July 2023 at a tertiary center. The primary outcome was AL following esophagectomy, while secondary outcomes included time to cancer recurrence and overall survival. Perioperative patient factors were evaluated to determine their associations with both the primary and secondary outcomes. Propensity score matched logistic regression assessed associations between perioperative factors and AL. Kaplan-Meier survival curves compared cancer recurrence and overall survival by AL. RESULTS: A total of 251 consecutive patients with esophageal cancer were included in the analysis; 15 (6%) developed AL. Anemia, hospital complications, hospital length of stay and 30-day readmissions significantly differed from those with and without AL (p = 0.037, < 0.001, < 0.001, and 0.016, respectively). Thirty and 90-day mortality were not statistically affected by presence of AL (p = 0.417, and 0.456, respectively). Logistic regression modeling showed drug history and anemia were significantly associated with AL (p = 0.022 and 0.011, respectively). The presence of AL did not significantly impact cancer recurrence or overall survival (p = 0.439 and 0.301, respectively). CONCLUSION: The etiology of AL is multifactorial. Anastomotic leak is significantly associated with drug history, preoperative anemia, hospital length of stay and 30-day readmissions, but it was not significantly associated with 30- or 90-day mortality, cancer recurrence or overall survival. Patients should be optimized prior to undergoing MIE with special consideration for correcting anemia. Ongoing research is needed to identify more modifiable risk factors to minimize AL development and its associated morbidity.