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
ARTICLE HIGHLIGHTS
Research background

Despite improvements in surgical procedures and peri-operative patients management, complications after surgery for esophagogastric junction (EGJ) cancer remain high because of technical difficulty.

Research motivation

No study has shown the influence of postoperative complications on the long-term outcomes of patients with EGJ cancer.

Research objectives

To elucidate the influence of postoperative complications, such as anastomotic leakage and pneumonia, on the long-term outcomes of patients with EGJ cancer.

Research methods

We retrospectively analyzed 122 patients who underwent surgery for EGJ cancer, investigating the association between postoperative complications and oncological outcomes.

Research results

We identified anastomotic leakage as a significant risk factor for death and cancer recurrence. We did not observe this tendency in patients who underwent cervical anastomosis but did see this tendency in patients who underwent intrathoracic anastomosis.

Research conclusions

Postoperative anastomotic leakage was significantly associated with survival in patients with EGJ cancer. Cervical anastomosis with esophagectomy may be an option for patients with a high risk of anastomotic leakage.

Research perspectives

A prospective study is required to confirm the association between complications and long-term outcomes of patients with EGJ cancer.