The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy. Issue 6 (December 2015)

• Record Type: Journal Article
• Authors: Markar, Sheraz; Gronnier, Caroline; Duhamel, Alain; Mabrut, Jean-Yves; Bail, Jean-Pierre; Carrere, Nicolas; Lefevre, Jérémie H.; Brigand, Cécile; Vaillant, Jean-Christophe; Adham, Mustapha; Msika, Simon; Demartines, Nicolas; Nakadi, Issam El; Meunier, Bernard; Collet, Denis; Mariette, Christophe
• Is Part Of: Annals of surgery. Volume 262:Issue 6(2015:Dec.)
• Publication Date: 2015-12
• Subjects: anastomotic leak -- esophageal neoplasms -- general surgery -- local -- neoplasm recurrence -- review -- survival; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001011
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of this study was to the determine impact of severe esophageal anastomotic leak (SEAL) upon long-term survival and locoregional cancer recurrence. Background: The impact of SEAL upon long-term survival after esophageal resection remains inconclusive with a number of studies demonstrating conflicting results. Methods: A multicenter database for the surgical treatment of esophageal cancer collected data from 30 university hospitals (2000–2010). SEAL was defined as a Clavien-Dindo III or IV leak. Patients with SEAL were compared with those without in terms of demographics, tumor characteristics, surgical technique, morbidity, survival, and recurrence. Results: From a database of 2944 operated on for esophageal cancer between 2000 and 2010, 209 patients who died within 90 days of surgery and 296 patients with a R1/R2 resection were excluded, leaving 2439 included in the final analysis; 208 (8.5%) developed a SEAL and significant independent association was observed with low hospital procedural volume, cervical anastomosis, tumoral stage III/IV, and pulmonary and cardiovascular complications. SEAL was associated with a significant reduction in median overall (35.8 vs 54.8 months; P = 0.002) and disease-free (34 vs 47.9 months; P = 0.005) survivals. After adjustment of confounding factors, SEAL was associated with a 28% greater likelihood of death [hazard ratio = 1.28; 95% confidence interval (CI): 1.04–1.59; P = 0.022], as well as greater overall (OR = 1.35; 95% CI: 1.15–1.73; P = 0.011), locoregional (OR = 1.56; 95% CI: 1.05–2.24; P = 0.030), and mixed (OR = 1.81; 95% CI: 1.20–2.71; P = 0.014) recurrences. Conclusions: This large multicenter study provides strong evidence that SEAL adversely impacts cancer prognosis. The mechanism through which SEAL increases local recurrence is an important area for future research.