Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2022; 14(1): 46-55
Published online Jan 27, 2022. doi: 10.4240/wjgs.v14.i1.46
Association of anastomotic leakage with long-term oncologic outcomes of patients with esophagogastric junction cancer
Masashi Takeuchi, Hirofumi Kawakubo, Satoru Matsuda, Shuhei Mayanagi, Tomoyuki Irino, Jun Okui, Kazumasa Fukuda, Rieko Nakamura, Norihito Wada, Hiroya Takeuchi, Yuko Kitagawa
Masashi Takeuchi, Hirofumi Kawakubo, Satoru Matsuda, Shuhei Mayanagi, Tomoyuki Irino, Kazumasa Fukuda, Rieko Nakamura, Norihito Wada, Yuko Kitagawa, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
Jun Okui, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
Hiroya Takeuchi, Department of Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
Author contributions: All authors give final approval of the manuscript and agree to be accountable for all aspects of the work; Takeuchi M contributed to the literature search, study design, analysis plan, data analysis and interpretation, drafting of manuscript; Kawakubo H contributed to the study design, data analysis and interpretation, manuscript revision; Matsuda S and Mayanagi S contributed to the data interpretation and analysis, manuscript revision; Irino T, Fukuda K, Nakamura R and Wada N contributed to the study design, data interpretation and analysis; Okui J contributed to the data interpretation and analysis; Takeuchi H contributed to the study design, analysis plan, data interpretation and analysis; Kitagawa Y contributed to the study design, manuscript revision.
Institutional review board statement: This study was conducted with the approval of the ethics committee of the Keio University School of Medicine.
Informed consent statement: The study participant was provided with an informed written consent prior to study enrollment.
Conflict-of-interest statement: Kitagawa Y received lecture fees from Chugai Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd, Asahi Kasei Pharma Corporation, Otsuka Pharmaceutical Factory Inc., Shionogi & Co., Ltd., Nippon Covidien Inc., Ono Pharmaceutical Co., Ltd., Bristol-Myers Squibb K.K.. Kitagawa Y was supported by grants from Chugai Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd, Yakult Honsha Co. Ltd., Asahikasei Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Tsumura & Co., Kyouwa Hakkou Kirin Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Ea Pharma Co., Ltd., Astellas Pharma Inc., Toyama Chemical Co., Ltd., Medicon Inc., Kaken Pharmaceutical Co. Ltd., Eisai Co., Ltd., Otsuka Pharmaceutical Factory Inc., Teijin Pharma Limited., Nihon Pharmaceutical Co., Ltd., and Nippon Covidien Inc. Kitagawa Y held an endowed chair provided by Chugai Pharmaceutical Co., Ltd. and Taiho Pharmaceutical Co., Ltd, outside the submitted work. Other authors declare no conflict-of-interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at hkawakubo@z3.keio.jp.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hirofumi Kawakubo, MD, PhD, Associate Professor, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. hkawakubo@z3.keio.jp
Received: March 25, 2021
Peer-review started: March 25, 2021
First decision: June 16, 2021
Revised: June 29, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 27, 2022
Processing time: 299 Days and 14.8 Hours
Abstract
BACKGROUND

Despite improvements in surgical procedures and peri-operative patients management, the postoperative complications in esophagogastric junction (EGJ) cancer remain high because of technical aspects. Several studies have indicated the negative influence of postoperative infectious complications on long-term survival after gastrointestinal surgery. However, no study has shown the association between postoperative complications and long-term survival of patients with EGJ cancer.

AIM

To elucidate influence of postoperative complications on the long-term outcomes of patients with EGJ cancer.

METHODS

A total of 122 patients who underwent surgery for EGJ cancer at the Keio University were included in this study. We examined the association between complications and long-term oncologic outcomes.

RESULTS

In all patients, the 3-year overall survival (OS) rate was 71.9%, and the recurrence-free survival (RFS) rate was 67.5%. Compared with patients without anastomotic leakage, those with anastomotic leakage had poor median OS (8 mo vs not reached, P = 0.028) and median RFS (5 mo vs not reached, P = 0.055). Among patients with cervical anastomosis, there were not significant differences between patients with and without anastomotic leakage. However, among patients who underwent intrathoracic anastomosis, patients with anastomotic leakage had significantly worse OS (P = 0.002) and RFS (P = 0.005).

CONCLUSION

Anastomotic leakage was significantly associated with long-term oncologic outcomes of patients with EGJ cancer, especially those who underwent intrathoracic anastomosis. Cervical anastomosis with subtotal esophagectomy may be an option for the patients who are at high risk for anastomotic leakage.

Keywords: Esophagogastric junction cancer, Complication, Long-term outcome

Core Tip: The postoperative complications of gastrointestinal surgery had been reported to have a remarkable effect on the long-term outcomes, but no study had examined this association in esophagogastric junction (EGJ) cancer. This retrospective study found that anastomotic leakage was remarkably associated with the survival of patients with EGJ cancer who underwent intrathoracic anastomosis but not cervical anastomosis. Cervical anastomosis with subtotal esophagectomy may be an option for patients who have a high risk for anastomotic leakage.