A nomogram illustrating the probability of anastomotic leakage following cervical esophagogastrostomy
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A nomogram illustrating the probability of anastomotic leakage following cervical esophagogastrostomy Joerg Lindenmann1 · Nicole Fink‑Neuboeck1 · Christian Porubsky1 · Melanie Fediuk1 · Udo Anegg1 · Peter Kornprat2 · Maria Smolle3 · Alfred Maier1 · Josef Smolle4 · Freyja Maria Smolle‑Juettner1 Received: 26 April 2020 / Accepted: 16 October 2020 © The Author(s) 2020
Abstract Background Early diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult. Estimation of an individual probability could help to establish preventive and diagnostic measures. The predictive impact of epidemiological, surgery-related data and laboratory parameters on the development of anastomotic dehiscence was investigated in the immediate perioperative period. Methods Retrospective study in 412 patients with cervical esophagogastrostomy following esophagectomy. Epidemiological data, risk factors, underlying disease, pre-treatment- and surgery-related data, C-reactive protein and albumin levels preand post-operatively were evaluated. We applied univariable and multivariable logistic regression analysis and developed a nomogram for individual risk assessment. Results There were 345 male, 67 female patients, mean aged 61.5 years; 284 had orthotopic, 128 retrosternal gastric pull-up; 331 patients had carcinoma, 81 non-malignant disease. Mean duration of operation was 184 min; 235 patients had manual, 113 mechanical and 64 semi-mechanical suturing; 76 patients (18.5%) developed anastomotic dehiscence clinically evident at mean 11.4 days after surgery. In univariable testing young age, retrosternal conduit transposition, manual suturing, high body mass index, high ASA and high postoperative levels of C-reactive protein were predictors for anastomotic leakage. These six parameters which had yielded a p < 0.1 in the univariable analysis, were entered into a multivariable analysis and a nomogram allowing the determination of the patient’s individual risk was created. Conclusion By using the nomogram as a supportive measure in the perioperative management, the patient’s individual probability of developing an anastomotic leak could be quantified which may help to take preventive measures improving the outcome. Keywords Cervical esophagogastrostomy · Anastomotic leakage · Risk factors · Scoring · Prediction · Postoperative care Esophagectomy is the treatment of choice for curative therapy of non-metastasized esophageal cancer and for a * Joerg Lindenmann [email protected] 1
Division of Thoracic Surgery and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/3, 8036 Graz, Austria
2
Department of General Surgery, Medical University of Graz, Graz, Austria
3
Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
4
Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
variety of benign, mostly end-stage esophageal diseases, respectivel
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