Influence of site of anastomosis (cervical or thoracic) on morbidity and mortality from esophagectomies

Abstract

Background. To evaluate the influence of the site of the anastomosis (cervical or intrathoracic) on postoperative complications and mortality from esophagectomies with two-field lymphadenectomy. Methods. Retrospective study of 132 patients with esophageal cancer submitted to esophagectomy with cervical or intrathoracic anastomosis admitted in Department of Surgery in Erasto Gaertner Hospital from January 1987 to January 1998. Patientrelated variables (gender, age, overall condition, weight loss, co-morbidities, tabagism), tumor-related variables (histological type, site, staging), and to surgical procedure variables (type and site of anastomosis, surgical time, hospitalization time) were recorded and related to postoperative complications and mortality. Results. Ninety-nine patients (71.2%) were males. The predominant histological type was squamous cell carcinoma, in 94.7% of the cases. The main co-morbidities reported were chronic obstructive pulmonary disease (29.55%) and arterial hypertension (15.15%), and 88 patients (66.6%) were smokers. The main tumor site was the inferior thoracic segment (56,06%). Six patients (4.54%) were stage I, 44 (33.33%) IIA, 24 (18.18%) IIB, 38 (28.80%) III and 17 (12.90%) IV. The intrathoracic anastomosis was performed in 105 patients (79.55%), and cervical in 27 (20.45%). The complication rate was 39.3% and hospital mortality, 13.70%. Mechanical anastomosis was performed in 65.09% of cases, and manual in 39.91%. Cervical leak occurred in 6 patients (23.1%), and 3 (2.9%) had intrathoracic leak (p = 0.002). The specific mortality was 33.3% in both subgroups. Conclusion. This study showed a higher occurrence of leakage in cervical anastomosis. The postoperative mortality was equal in both techniques, contradicting the literature tendency to attribute lower lethality to cervical leakage.