Risk factors for the development of respiratory complications and anastomotic leakage after esophagectomy

Abstract

Purpose: Exploring potential risk factors for development of two major postoperative complications after esophagectomy. Methods: A literature review was performed during late 2013 until spring 2015, based on Pubmed searches with the words “anastomotic leakage”, “pulmonary complications”, “risk factors”, “risk stratification”, “esophagectomy“ and associated synonyms. Almost all types of studies were included. Results: Significant factors found for pulmonary complications were FEV1, ASA score, pulmonary and general comorbidities, lack of physiotherapy, smoking and alcohol consumption, low BMI and sarcopenia, proximal tumor localization, performance status, diabetes and T-stage. Increased blood loss, length of operation and stapler technique, lack of thoracic epidural analgesia, inotrope usage, anastomotic leakage, abdominal complications and not providing enteral feeding by jejunostomy tube. Factors found to increase the likelihood of anastomotic leakage were low S-albumin level, low BMI, high ASA score, arterial calcification, blood loss, not providing omentoplasty, cervical anastomosis, long duration of surgery, posterior placement of the gastric tube, lack of epidural analgesia, respiratory and general complications and delayed gastric emptying. Conclusion: Several factors were significant for complications after esophagectomy. Some have conflicting results, and need further research. The majority of the results in this study concern general performance, airways and function of the thorax and may therefore affect tissue oxygenation. Preoperative optimization may improve postoperative results. This subject needs more RCTs and large studies to validate the factors. The causes of these two complications are multifactorial and future research should aim to find risk scores for their development.