Florida State University, Sarasota Memorial Hospital Sarasota, FL, United States
Mindy Ward, DO1, Katherine Burns, DO2, Ian Nora, MD2, Jamie Huston, RN3, Ravi Shridhar, MD4, Kenneth Meredith, MD3 1Florida State University, Sarasota Memorial Hospital, Sarasota, FL; 2Florida State University, Sarasota, FL; 3Sarasota Memorial Hospital, Sarasota, FL; 4Advent Health, Orlando, FL
Introduction: Management of esophageal cancer with surgical resection is imperative for curative treatment. Anastomotic leak (AL) following esophagectomy requires quick diagnosis and prompt management. This retrospective study was designed to examine associations between neoadjuvant treatment, smoking history and extant comorbidities in esophagectomy patients who did vs. did not experience AL.
Methods: After IRB approval, we identified patients in a prospectively built database who underwent single-surgeon esophagectomy between 1996 and 2020. Patient characteristics, endpoints and outcomes were analyzed with Mann-Whitney U and Pearson’s Chi-square as appropriate.
Results: Among 978 patients, 56 experienced AL. The patient demographics were equally distributed with a median age (66 [28-91]), sex (83%) male, and race (95.7% White, 1.3 % Black, 1.8% Hispanic, 1.1% other). The average patient BMI was 27.3 ± 5.7 kg/m². There were no intergroup subject differences in histology or staging respectively, thus pooled data included 819 (83.7%) adenocarcinoma, 118 (12.1%) squamous cell carcinoma, and 41 (4.2%) others. The pathologic T-stage of patients was T0-2 703 (71.9%), T3-4 250 (25.6%), and unknown 25 (2.6%). The pathologic N-stages included N0 651 (66.6%) and N+ 299 (30.6%). Known preexisting comorbidities in 56 AL patients included smoking history in 48 (85.7%) p = 0.02, cardiac disease 16 (28.6%), pulmonary disease 13 (21.4%) p = 0.3, diabetes 12 (21.4%), renal disease 3 (5.4%), liver disease 2 (3.6%), and 50% underwent neoadjuvant chemotherapy (p = 0.01). Preoperative average albumin was 3.7±0.6 g/dL, with 52% of patients exhibiting albumin >3.0 gm/dL, neutropenia was rare (3.6%) with 39.3% receiving radiation. All AL patients requiring reoperation had a history of smoking (n=8) while 75% had undergone neoadjuvant chemotherapy.
Discussion: Smoking and pulmonary disease were the only comorbidities associated with AL. Cardiac, diabetic, renal, and liver disease independently across demographics were not associated with AL. Further research is warranted to examine whether interactions between smoking history, neoadjuvant chemotherapy and/or combinations of comorbidities escalate risk for post esophagectomy AL.
Disclosures: Mindy Ward indicated no relevant financial relationships. Katherine Burns indicated no relevant financial relationships. Ian Nora indicated no relevant financial relationships. Jamie Huston indicated no relevant financial relationships. Ravi Shridhar indicated no relevant financial relationships. Kenneth Meredith indicated no relevant financial relationships.
Mindy Ward, DO1, Katherine Burns, DO2, Ian Nora, MD2, Jamie Huston, RN3, Ravi Shridhar, MD4, Kenneth Meredith, MD3. P2379 - Anastomotic Leaks Post Esophagectomy: Do Comorbidities Matter?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.