Clinical impact of low fornix perfusion on devascularized whole stomach as a risk factor for anastomotic leakage after esophagectomy

Backgrounds

We previously reported poor vascularity of narrow gastric tube evaluated by thermography was associated with anastomotic leakage (AL) after esophagectomy. Meanwhile, the association between the fornix low perfusion on devascularized whole stomach (DWS) and the incidence of AL remains unclear. Therefore, this study aimed to clarify the impact of the fornix low perfusion on DWS.

Methods

A total of 238 patients who underwent Mckeown esophagectomy with gastric tube reconstruction between 2008 and 2021 were analyzed. Patients were divided into non-AL and AL groups and their clinical outcomes including vascular factors of DWS and gastric tube were compared. Additionally, the logistic regression analysis was conducted to detect the risk factors of AL.

Results

AL occurred in 31 patients (13.0%). Regarding vascular factors, avascular area temperature retain rate (Av-TRr) on DWS, right gastroepiploic artery length rate and anastomotic viability index (AVI) on gastric tube were significantly smaller in the AL group than in the non-AL group. In logistic regression model for AL, multivariate analysis showed that diabetes (Odds ratio [OR], 3.90; 95% confidence interval [CI], 1.32–11.60), hand-sewn anastomosis (OR, 4.42;95% CI, 1.05–18.60), Av-TRr on DWS<0.91 (OR, 4.67; 95% CI, 2.00–10.90), and AVI<0.64 (OR, 2.68; 95% CI, 1.12–6.39) were significant risk factors.

Conclusions

Fornix low perfusion on DWS was a risk factor of AL as well as low AVI on gastric conduit. Additionally, fornix low perfusion on DWS was correlated with low AVI on gastric conduit.