Do alterations in plasma albumin and prealbumin after minimally invasive esophagectomy for squamous cell carcinoma influence the incidence of cervical anastomotic leak?

BACKGROUND: Anastomotic leak (AL) remains a challenging and bothersome complication of minimally invasive esophagectomy (MIE). In this retrospective study, we measured the perioperative albumin (ALB) and prealbumin (PA) of patients who underwent MIE, and investigated the relationship between the occurrence of AL and the altering levels of ALB/PA.

PATIENTS AND METHODS: Sixty patients underwent video-assisted thoracoscopic-laparoscopic esophagectomy between September 2013 and August 2014. The preoperative and postoperative levels of ALB and PA were detected, and the baseline of altering levels for ALB and PA were established. According to the decreasing values of postoperative ALB, patients were divided into Group A1 (decreased value of ALB over the average level) and Group A2 (decreased value of ALB not reach the average level). Similarly, patients were also divided into Group P1 and Group P2 according to the average decreasing values of postoperative PA. The incidence of AL and non-anastomotic-relative complications between different groups were calculated and analyzed.

RESULTS: One postoperative death occurred (1/60, 1.7 %). Eighteen complications were observed (18/60, 30 %), including seven cases of cervical AL (7/60, 11.7 %). There was no significant difference in background or clinicopathologic factors between different groups. The levels of ALB and PA descended significantly after MIE (p = 0.0000, p = 0.0000, respectively). No correlation between deficient levels of ALB and PA was observed (p = 0.1874, r = 0.0298). There was a significant higher AL incidence in Group P1 than in Group P2 (p = 0.0322). However, the incidence of AL did not exhibit significant difference between Group A1 and Group A2 (p = 0.9252).

CONCLUSIONS: MIE appears to be a procedure of obvious influence on the nutrient metabolism of patients. The results demonstrated that patients with severely deficient level of PA had higher risk of AL after MIE.