Current Approaches to Predicting Esophagogastric Anastomotic Leakage after Subtotal Esophagectomy

Abstract

Background : Anastomotic leakage remains one of the most severe complications after esophagectomy and is associated with an increased rate of reinterventions, prolonged hospital stay, and higher postoperative mortality. Objective : To evaluate the prognostic value of inflammatory markers in the early postoperative period in patients after subtotal esophagectomy and to develop a postoperative risk stratification model for anastomotic leakage. Materials and methods : A multicenter retrospective comparative study was conducted. The analysis included 325 patients with morphologically verified malignant tumors of the esophagus and/or esophagogastric junction who underwent subtotal esophagectomy using the Ivor Lewis or McKeown approach. Clinical, anamnestic, tumor-related, intraoperative, and laboratory parameters were analyzed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and Creactive protein (CRP) levels were assessed preoperatively and on postoperative days 1 and 5. Results: Anastomotic leakage was diagnosed in 48 of 325 patients (14.8%). In univariate analysis, anastomotic leakage was associated with the surgical approach (Ivor Lewis/McKeown), tumor location and length, severity of dysphagia, smoking status, Charlson Comorbidity Index, blood transfusion, and anemia status. Among the laboratory parameters, the most pronounced intergroup differences were observed on postoperative day 5: patients with anastomotic leakage had higher NLR, PLR, and CRP levels and lower PNI values. The final multivariable model included PNI5 (AOR 0.863; 95% CI 0.773–0.964; p = 0.009), PLR5 (AOR 1.009; 95% CI 1.005–1.012; p < 0.001), and CRP5 (AOR 1.007; 95% CI 1.001–1.012; p = 0.013). The model demonstrated excellent discriminative performance in the study cohort (AUC = 0.922; 95% CI 0.868–0.975; p < 0.001). Conclusion: In patients after esophagectomy, CRP, PLR, and PNI on postoperative day 5 were independent predictors of anastomotic leakage. Increased CRP and PLR levels, along with decreased PNI values, were associated with a higher risk of this complication. The model based on these parameters demonstrated high discriminatory performance and may be used for early postoperative risk stratification. However, external validation in independent patient cohorts is required before clinical implementation.