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Evaluation of Fibrin Sealant in Prevention of Cervical Anastomotic Leakage After McKeown Esophagectomy: A Single-Center, Retrospective Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Anastomotic leakage remains an issue after esophagectomy for patients with esophageal or esophagogastric junction cancer. Previous studies have indicated that the intraoperative application of fibrin sealant may reduce the incidence of postoperative anastomotic leakage. This retrospective study was aimed to evaluate the efficacy and safety of fibrin sealant in the prevention of anastomotic leakage in patients undergoing McKeown esophagectomy.

Methods

We designed a single-center, retrospective study. Between January 2018 and December 2019, 227 patients with esophageal or esophagogastric junction cancer undergoing McKeown esophagectomy performed by our team were retrospectively identified, of whom 86 patients were included in the FS group and 141 patients were included in the control group. Intraoperatively, 2.5 ml of porcine fibrin sealant was applied circumferentially to the cervical anastomosis after the anastomosis was created in the FS group. The primary outcome was the incidence of cervical anastomotic leakage within the first three months after surgery.

Results

The differences in baseline clinical characteristics between the two groups were not significant except for a history of drinking. In the FS group, the postoperative cervical anastomotic leakage rate was lower (FS group: 4.7% [4 of 82] vs. control group: 19.9% [28 of 141], p < 0.01). Multivariate logistic regression showed that the intraoperative application of fibrin sealant was an independent protective factor for anastomotic leakage (OR 0.169, 95% CI 0.055-0.515, p = 0.002).

Conclusions

The intraoperative application of fibrin sealant could possibly prevent cervical anastomotic leakage after McKeown esophagectomy with satisfactory safety. Further prospective clinical trials are warranted.

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Acknowledgments

We thank all the patients and their families who participated in this study. We also thank Qing Liu for her help in the statistical analyses and interpretation. The study was supported in part by grants from the National Natural Science Foundation of China (Grant Nos. 81402003 and 81972614).

Funding

This study was supported in part by grants from the National Natural Science Foundation of China (Grant Nos. 81402003 and 81972614).

Author information

Author notes

  1. Yan Huang, Yihuai Hu, Yaobin Lin, Jianhua Fu have contributed equally to this work.

  2. Min Liu and Yang Hong are senior authors and contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China

    Yan Huang MD, Yihuai Hu MD, Yaobin Lin MD, Jianhua Fu MD, Jiadi Wu MD, Caiyan Fang MD & Yang Hong MD

  2. Department of Ultrasound and Electrocardiogram, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China

    Min Liu MD

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  1. Yan Huang MD
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  2. Yihuai Hu MD
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Contributions

H Yang, M Liu, and J Fu contributed to the study design. Y Huang, Y Hu, and Y Lin contributed to data analyses and drafting of the manuscript. J Wu and C Fang were involved in data collection. All the authors participated in data interpretation and contributed to writing and critical review of the manuscript. All authors gave final approval to submit for publication.

Corresponding author

Correspondence to Yang Hong MD.

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Huang, Y., Hu, Y., Lin, Y. et al. Evaluation of Fibrin Sealant in Prevention of Cervical Anastomotic Leakage After McKeown Esophagectomy: A Single-Center, Retrospective Study. Ann Surg Oncol 28, 6390–6397 (2021). https://doi.org/10.1245/s10434-021-09877-0

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  • DOI: https://doi.org/10.1245/s10434-021-09877-0

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