Superior Thoracic Aperture Size is Significantly Associated with Cervical Anastomotic Leakage After Esophagectomy

The size of the superior thoracic aperture (STA) may be associated with the incidence of cervical anastomotic leakage after esophagectomy. Using computed tomography (CT) images, we retrospectively investigated relationships between the size of the STA and anastomotic leakage following esophagectomy using the retrosternal or posterior mediastinal reconstruction routes.

Patients who underwent cervical esophagogastrostomy after esophagectomy between 2009 and 2015 were enrolled in this retrospective study (n = 326). The size of the STA was measured at the level of the sternal notch using preoperative CT images, and it was determined as the anteroposterior diameter of the STA minus the diameter of the trachea. Associations between clinical factors, including the size of the STA, and anastomotic leakage were determined.

Anastomotic leakage occurred in 44 patients (13.5%). The size of the STA ranged from 0 to 49 mm (median, 16 mm). In univariate analyses, the duration of the operation, tumor location, anastomotic procedure, and the size of the STA were significantly associated with anastomotic leakage. In multivariate analysis, only the size of the STA was independently related to leakage (odds ratio 1.05; 95% confidence interval 1.002-1.107; p = 0.027). The size of the STA affected the incidence of leakage more frequently with the posterior mediastinal route than with the retrosternal route.

The size of the STA was significantly associated with the incidence of anastomotic leakage after esophagectomy, especially when using the posterior mediastinal route.