Influence Of Oblique Anastomosis On Esophagogastric Anastomotic Leak And Its Risk Factors

Objective: To investigate the benefit of oblique anastomosis on esophagogastric anastomotic leak and the risk factors of this technique. Methods: According to surgical method, one hundred and five patients with esophageal cancer were retrospectively included and divided into the experimental group (n=45, side to side anastomosis) and the control group (n=60, end to side anastomosis). The patients in the experimental group underwent oblique anastomosis while those in the control group underwent end-to-side anastomosis. The area around the anastomotic stoma, total amount of drainage after operation, bed rest time and adverse outcomes were compared between the two groups. The patients were followed-up for 3 years to observe the survival rates in both groups. Results: The anastomotic area in the experimental group was significantly larger than that in the control group; the total amount of drainage after operation in the experimental group was significantly lower than that in the control group and the bed rest time was also significantly shorter. There were no significant differences in the complications in the two groups except higher anastomotic leak incidence in control group (P=0.347, P=0.546). The incidence of adverse reactions (anastomotic leakage, anastomotic stenosis and chest-stomach syndrome) in the control group was higher than that in the experimental group (P=0.010). Multivariate analysis showed that age (OR: 4.422, 95% CI: 1.284-15.225) and anastomotic mode (OR: 4.302, 95% CI: 1.109-16.688) were the independent risk factors for anastomotic leak and increasing incidence of anastomotic leakage was found with older age. Survival curves showed that sixty-eight patients (64.76%) survived over three years after operation and there was no significant difference in the 3-year survival rate between the two groups (P=0.245). Conclusion: Age and anastomotic mode are the independent risk factors for anastomotic leak. Oblique anastomosis can increase anastomotic area, reduce postoperative drainage and bed rest time and the total incidence of complications; however, it has no significant impact on patient survival.