Risk factors for benign anastomotic stricture post-oesophagectomy: single-centre analysis of 702 oesophagectomies with squamous cell carcinoma

BACKGROUND: Benign stricture formation after oesophagectomy makes a considerable impact on postoperative recovery, nutritional status and quality of life. Our aim was to investigate the incidence and risk factors for benign anastomotic stenosis post-oesophagectomy in a large series of patients. METHODS: We conducted a retrospective study of all patients undergoing oesophagectomy of oesophageal squamous cell carcinoma (ESCC) in our department from August 2012 to May 2013. Anastomotic stricture was identified clinically and radiologically. A total of 14 clinicopathological variables were assessed by univariate and multivariate logistic regression analyses. RESULTS: The study included 702 patients, and anastomotic stricture occurred in 62 patients (8.8%), which was significantly higher after cervical (20.8%) anastomosis than below (7.4%) or above (6.6%) aortic arch anastomosis. The anastomotic stricture rate was 31.8% in single-layer hand sewn (s-HS) anastomosis, 11.7% in circular stapled (CS) anastomosis, 10.4% in double-layer hand-sewn (d-HS) anastomosis and 1.9% in semi-mechanical (SM) anastomosis. The univariate analysis found that hypertension, surgical approach, anastomotic technique, anastomosis site, total number of removed lymph node and anastomotic leakage were associated with anastomotic stricture rate (P<0.05). Age, gender, body mass index (BMI), history of smoking or diabetes, the length of tumour, pT stage, pN stage and historical grading showed no statistically significant difference in the incidence of benign stenosis (P>0.05). On multivariate analysis, anastomosis site (P=0.006) and anastomotic technique (P<0.001) were independently associated with stricture risk. CONCLUSIONS: Our study highlighted that patients with ESCC undergoing cervical anastomosis should be cautiously monitored postoperatively as a result of relative high stricture rate. SM technique is the preferred method of oesophago-gastric anastomosis due to a decreased stricture formation compared with other techniques.