Anastomotic leakage after esophagogastric resection increases recurrence risk and impairs long-term survival – a propensity score-matched analysis

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Abstract Background Esophagogastric resection is the curative treatment for upper gastrointestinal (uGI) tumors but carries risks such as anastomotic leakage (AL). While AL is known to negatively influence oncological outcomes in other cancer entities, its impact on long-term survival in uGI tumors remains unclear. The aim of the study was to determine the rates of tumor recurrence (TR), recurrence patterns, and overall survival (OS) in patients who experienced AL after esophagogastric resection. Materials and methods This retrospective cohort study was conducted at the University Hospital Carl Gustav Carus Dresden from January 2013 to December 2019. Patients who underwent esophagectomy or gastrectomy for histologically confirmed carcinoma of the uGI tract were included. After 2:1 propensity score matching, a total of 185 patients with complete 5-year-follow-up were analyzed. Results Overall tumor recurrence rates did not differ significantly between patients with AL (AL+) and without AL (AL-) (46.3% vs. 39.0%, p = 0.386). However, stratified analysis revealed a higher risk of hematogenous recurrence in the AL+ group (HR 1.701, 95% CI 1.051–2.753, p = 0.031) in the cause-specific Cox model, while this association was not significant in the Fine–Gray analysis accounting for competing risks. Median OS was worse in the AL+ group (33 vs. 42 months, p = 0.007). Conclusion AL after esophagogastric resection was associated with worse long-term OS and a higher current risk of hematogenous recurrence. Since this association was observed only in the cause-specific Cox model and not in the Fine–Gray model, results should be interpreted cautiously. Although overall recurrence rates were similar, the pattern of recurrence differed, highlighting the importance of analyzing recurrence types. Strategies to reduce AL and further research into its biological impact are warranted.

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