Risk factors for anastomotic leakage following esophagectomy: Impact of thoracic epidural analgesia

BACKGROUND AND OBJECTIVES: Anastomotic leakage (AL) is one of common complications after esophageal cancer surgery. Thoracic epidural analgesia (TEA) is often recommended in patients undergoing esophagectomy. However, the impact of TEA on AL is still controversial. Thus, we conducted this study to evaluate the effect of TEA on the occurrence of AL and identify risk factors for the development of AL following esophagectomy. METHODS: Our retrospective study identified patients who underwent elective esophagectomy between July 2013 and July 2016. Univariate and multivariate logistics analyses and propensity score matching analysis were conducted to identify the risk factors for AL occurring within 30 days after operation. RESULTS: Overall 30-day AL was 7.9%. Multivariate analysis revealed that surgical procedure (Sweet: referent; Ivor-Lewis: OR 2.854; 95%CI 1.726-4.718; Three-incision: OR 4.837; 95%CI 3.457-6.768) and surgeon (high-volume: referent; low-volume: OR 1.740; 95%CI 1.269-2.384) were independent risk factors for AL after esophagectomy. No statistically significant difference was observed in the incidences of AL between the epidural analgesia group and the intravenous analgesia group either before or after propensity score matching (9.1% vs 7.7%, P = 0.359; 8.3% vs 9.2%, P = 0.683). CONCLUSIONS: TEA does not affect the AL risk after esophagectomy.