Abstract
Background
Anastomotic leak (AL) remains a challenging and bothersome complication of minimally invasive esophagectomy (MIE). In this retrospective study, we measured the perioperative albumin (ALB) and prealbumin (PA) of patients who underwent MIE, and investigated the relationship between the occurrence of AL and the altering levels of ALB/PA.
Patients and methods
Sixty patients underwent video-assisted thoracoscopic–laparoscopic esophagectomy between September 2013 and August 2014. The preoperative and postoperative levels of ALB and PA were detected, and the baseline of altering levels for ALB and PA were established. According to the decreasing values of postoperative ALB, patients were divided into Group A1 (decreased value of ALB over the average level) and Group A2 (decreased value of ALB not reach the average level). Similarly, patients were also divided into Group P1 and Group P2 according to the average decreasing values of postoperative PA. The incidence of AL and non-anastomotic-relative complications between different groups were calculated and analyzed.
Results
One postoperative death occurred (1/60, 1.7 %). Eighteen complications were observed (18/60, 30 %), including seven cases of cervical AL (7/60, 11.7 %). There was no significant difference in background or clinicopathologic factors between different groups. The levels of ALB and PA descended significantly after MIE (p = 0.0000, p = 0.0000, respectively). No correlation between deficient levels of ALB and PA was observed (p = 0.1874, r = 0.0298). There was a significant higher AL incidence in Group P1 than in Group P2 (p = 0.0322). However, the incidence of AL did not exhibit significant difference between Group A1 and Group A2 (p = 0.9252).
Conclusions
MIE appears to be a procedure of obvious influence on the nutrient metabolism of patients. The results demonstrated that patients with severely deficient level of PA had higher risk of AL after MIE.
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References
Aminian A, Panahi N, Mirsharifi R, Karimian F, Meysamie A, Khorgami Z, Alibakhshi A (2011) Predictors and outcome of cervical anastomotic leakage after esophageal cancer surgery. J Cancer Res Ther 7:448–453
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90
Zeng H, Zheng R, Guo Y, Zhang S, Zou X, Wang N, Zhang L, Tang J, Chen J, Wei K, Huang S, Wang J, Yu L, Zhao D, Song G, Chen J, Shen Y, Yang X, Gu X, Jin F, Li Q, Li Y, Ge H, Zhu F, Dong J, Guo G, Wu M, Du L, Sun X, He Y, Coleman MP, Baade P, Chen W, Yu XQ (2015) Cancer survival in China, 2003–2005: a population-based study. Int J Cancer 136:1921–1930
Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:634–640
Taguchi S, Osugi H, Higashino M, Tokuhara T, Takada N, Takemura M, Lee S, Kinoshita H (2003) Comparison of threefield esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc 17:1445–1450
Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256:95–103
Rutegard M, Lagergren P, Rouvelas I, Lagergren J (2012) Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol 19:99–103
Walther B, Johasson J, Johnsson F, Von Holstein CS, Zilling T (2003) Cervical or thoracic anastomosis after esophageal randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg 238:803–812
Griffin SM, Lamb PJ, Dresner SM, Richardson DL, Hayes N (2001) Diagnosis and management of a mediastinal leak following radical oesophagectomy. Br J Surg 88:1346–1351
Patil PK, Patel SG, Mistry RC, Deshpande RK, Desai PB (1992) Cancer of the esophagus: esophagogastric anastomotic leak: a retrospective study of predisposing factors. J Surg Oncol 49:163–167
Pross M, Manger T, Reinheckel T, Mirow L, Kunz D, Lippert H (2000) Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc 51:73–76
Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS (2005) Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on long term survival in a high volume centre. Eur J Cardiothorac Surg 27:3–7
Tabatabai A, Hashemi M, Mohajeri G, Ahmadinejad M, Khan IA, Haghdani S (2009) Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med 4:197–200
Guo W, Zhao YP, Jiang YG, Niu HJ, Liu XH, Ma Z, Wang RW (2012) Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc 26:1332–1336
Zou YB, Yan H, Liu XH, Zhao YJ, Jiang YG, Wang RW, Guo W (2013) Lateral position could provide more excellent hemodynamic parameters during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc 27:3720–3725
Kauppi J, Räsänen J, Sihvo E, Huuhtanen R, Nelskylä K, Salo J (2015) Open versus minimally invasive esophagectomy: clinical outcomes for locally advanced esophageal adenocarcinoma. Surg Endosc 29:2614–2619
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–494
Anderegg MC, Gisbertz SS, van Berge Henegouwen MI (2014) Minimally invasive surgery for oesophageal cancer. Best Pract Res Clin Gastroenterol 28:41–52
Herrmann FR, Safran C, Levkoff SE, Minaker KL (1992) Serum albumin level on admission as a predictor of death, length of stay and readmission. Arch Intern Med 152:125–130
Ellebæk M, Qvist N, Fristrup C, Mortensen MB (2014) Mediastinal microdialysis in the diagnosis of early anastomotic leakage after resection for cancer of the esophagus and gastroesophageal junction. Am J Surg 208:397–405
Mears E (1996) Outcomes of continuous process improvement of a nutritional care program incorporating serum prealbumin measurements. Nutrition 12:479–484
Luechakiettisak P, Kasetsunthorn S (2008) Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study. J Med Assoc Thai 91:681–685
Worrell S, Mumtaz S, Tsuboi K, Lee TH, Mittal SK (2010) Anastomotic complications associated with stapled versus hand-sewn anastomosis. J Surg Res 161:9–12
Guo W, Zou YB, Ma Z, Niu HJ, Jiang YG, Zhao YP, Gong TQ, Wang RW (2013) One surgeon’s learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral position: how many cases are needed to reach competence? Surg Endosc 27:1346–1352
Scheepers JJ, van der Peet DL, Veenhof AA, Heijnen B, Cuesta MA (2010) Systematic approach of postoperative gastric conduit complications after esophageal resection. Dis Esophagus 23:117–121
Honda M, Kuriyama A, Noma H, Nunobe S, Furukawa TA (2013) Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg 257:238–248
Guo W, Zou YB, Ma Z, Niu HJ, Jiang YG, Zhao YP, Gong TQ, Wang RW (2013) One surgeon’s learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral position: how many cases are needed to reach competence? Surg Endosc 27:1346–1352
Aminian A, Panahi N, Mirsharifi R, Karimian F, Meysamie A, Khorgami Z, Alibakhshi A (2011) Predictors and outcome of cervical anastomotic leakage esophageal cancer surgery. J Cancer Res Ther 7:448–453
Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336
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Dr. Ying-Jian Wang, Dr. Xue-Hai Liu, Dr. Long-Yong Mei, Dr. Kun-Kun Li, Dr. Yao-Guang Jiang, Dr. Wei Guo have nothing to disclose about this paper. There is no conflict of interest for all authors.
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Wang, YJ., Liu, XH., Mei, LY. et al. Do alterations in plasma albumin and prealbumin after minimally invasive esophagectomy for squamous cell carcinoma influence the incidence of cervical anastomotic leak?. Surg Endosc 30, 3943–3949 (2016). https://doi.org/10.1007/s00464-015-4705-9
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DOI: https://doi.org/10.1007/s00464-015-4705-9