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Background <p>Although retrosternal route reconstruction is commonly used in esophagectomy, its anatomical constraints may increase the risk of anastomotic leakage because of the compression of reconstructed organs and deformation of the anastomosis. Therefore, this study retrospectively investigated the effect of anastomosis deformation on leakage.</p> Methods <p>In this study, 228 patients who underwent esophagectomy with the McKeown method and triangular anastomosis between 2009 and 2022 were included. The postoperative computed tomography images were analyzed to measure the axial deviation of the esophagogastric anastomosis in the coronal (AD-C) and sagittal (AD-S) images. Moreover, the relationship between axial deviation and anastomotic leakage was examined.</p> Results <p>No significant differences were observed between patients with and without anastomotic leakage in terms of patient background, cancer stage, or surgical technique. However, the patients with anastomotic leakage had significantly greater AD-C and AD-S values than those without. Multivariate analysis identified AD-C &gt; 20° as an independent risk factor for anastomotic leakage (odds ratio, 4.93; 95% confidence interval, 2.06–11.92; <i>p</i> &lt; 0.01).</p> Conclusions <p>The axial deviation of the esophagogastric anastomosis is a potential risk factor for anastomotic leakage during retrosternal reconstruction. Further studies incorporating three-dimensional imaging and biomechanical analysis are needed to clarify its impact and optimize the anastomotic geometry.</p>

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Axial deviation of anastomosis: a risk factor for leakage in retrosternal gastric tube reconstruction after esophagectomy

  • 期刊论文

  • 发表日期：

    2025年11月26日

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  • Takanori Kurogochi,
  • Naoko Fukushima,
  • Takahiro Masuda,
  • Keita Takahashi,
  • Kohei Uno,
  • Masami Yuda,
  • Akira Matsumoto,
  • Takashi Oshiro,
  • Fumiaki Yano,
  • Ken Eto

摘要

Background

Although retrosternal route reconstruction is commonly used in esophagectomy, its anatomical constraints may increase the risk of anastomotic leakage because of the compression of reconstructed organs and deformation of the anastomosis. Therefore, this study retrospectively investigated the effect of anastomosis deformation on leakage.

Methods

In this study, 228 patients who underwent esophagectomy with the McKeown method and triangular anastomosis between 2009 and 2022 were included. The postoperative computed tomography images were analyzed to measure the axial deviation of the esophagogastric anastomosis in the coronal (AD-C) and sagittal (AD-S) images. Moreover, the relationship between axial deviation and anastomotic leakage was examined.

Results

No significant differences were observed between patients with and without anastomotic leakage in terms of patient background, cancer stage, or surgical technique. However, the patients with anastomotic leakage had significantly greater AD-C and AD-S values than those without. Multivariate analysis identified AD-C > 20° as an independent risk factor for anastomotic leakage (odds ratio, 4.93; 95% confidence interval, 2.06–11.92; p < 0.01).

Conclusions

The axial deviation of the esophagogastric anastomosis is a potential risk factor for anastomotic leakage during retrosternal reconstruction. Further studies incorporating three-dimensional imaging and biomechanical analysis are needed to clarify its impact and optimize the anastomotic geometry.