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Background <p>Anastomotic leak (AL) is a significant complication after esophagectomy, occurring in 9–11% of cases, increasing morbidity and resource utilization. This study evaluated perioperative, surgical, and hemodynamic factors associated with AL after Ivor Lewis esophagectomy.</p> Methods <p>We conducted a retrospective study of patients who underwent Ivor Lewis esophagectomy for esophageal cancer between January 2018 and September 2024. Demographic, comorbidity, operative, vasopressor, and fluid management data were collected. Univariate analyses used Fisher’s exact and Mann–Whitney U tests. Variables with p &lt; 0.1 and clinically relevant covariates were included in stepwise multivariable logistic regression.</p> Results <p>Among 208 patients, 16 (7.7%) developed AL. Baseline demographics and neoadjuvant therapy did not differ between groups. In multivariable analysis, preoperative P2Y12 inhibitor therapy (OR 9.3, 95% CI 2.4–36.3, p &lt; 0.001) and intraoperative vasopressin administration (OR 4.0, 95% CI 1.3–12.0, p = 0.014) were independently associated with AL. Phenylephrine monotherapy had the lowest AL rate (3.6%), whereas the addition of vasopressin increased risk nearly fivefold (18%). Peripheral vascular disease was significant in univariate analysis but not retained in multivariable modeling. AL was associated with a prolonged hospital stay (median 18.5 vs 9&#xa0;days, p &lt; 0.001), higher 30-day readmission (25% vs 3.6%, p = 0.006), and increased reintubation (31.3% vs 12.0%, p = 0.046), but not with higher 30- or 90-day mortality.</p> Conclusions <p>Preoperative P2Y12 therapy and intraoperative vasopressin use were independently associated with AL after esophagectomy. P2Y12 therapy may reflect high-risk vascular biology, while vasopressor selection represents a modifiable factor. These findings warrant validation but support the careful selection of vasopressors and enhanced monitoring in P2Y12 patients.</p>

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Association of perioperative patient characteristics, intraoperative fluid management, and vasopressors with anastomotic leakage after Ivor-Lewis esophagectomy—a single center retrospective cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月17日

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  • Chelsea Yap,
  • Rachel Warner,
  • Amie L. Hoefnagel,
  • Saurin Shah,
  • Paul D. Mongan,
  • Ziad Awad

摘要

Background

Anastomotic leak (AL) is a significant complication after esophagectomy, occurring in 9–11% of cases, increasing morbidity and resource utilization. This study evaluated perioperative, surgical, and hemodynamic factors associated with AL after Ivor Lewis esophagectomy.

Methods

We conducted a retrospective study of patients who underwent Ivor Lewis esophagectomy for esophageal cancer between January 2018 and September 2024. Demographic, comorbidity, operative, vasopressor, and fluid management data were collected. Univariate analyses used Fisher’s exact and Mann–Whitney U tests. Variables with p < 0.1 and clinically relevant covariates were included in stepwise multivariable logistic regression.

Results

Among 208 patients, 16 (7.7%) developed AL. Baseline demographics and neoadjuvant therapy did not differ between groups. In multivariable analysis, preoperative P2Y12 inhibitor therapy (OR 9.3, 95% CI 2.4–36.3, p < 0.001) and intraoperative vasopressin administration (OR 4.0, 95% CI 1.3–12.0, p = 0.014) were independently associated with AL. Phenylephrine monotherapy had the lowest AL rate (3.6%), whereas the addition of vasopressin increased risk nearly fivefold (18%). Peripheral vascular disease was significant in univariate analysis but not retained in multivariable modeling. AL was associated with a prolonged hospital stay (median 18.5 vs 9 days, p < 0.001), higher 30-day readmission (25% vs 3.6%, p = 0.006), and increased reintubation (31.3% vs 12.0%, p = 0.046), but not with higher 30- or 90-day mortality.

Conclusions

Preoperative P2Y12 therapy and intraoperative vasopressin use were independently associated with AL after esophagectomy. P2Y12 therapy may reflect high-risk vascular biology, while vasopressor selection represents a modifiable factor. These findings warrant validation but support the careful selection of vasopressors and enhanced monitoring in P2Y12 patients.