RISKFACTORS AND PATHOGENIC MICROORGANISMS IN PATIENTS WITH LEAKAGE OFTHE ESOPHAGOJEJUNOSTOMY FOLLOWING TOTAL GASTRECTOMY

It ws the aim of the study to find by retrospective analysis of data f rom totally gastrectomized patients risk factors for the development o f esophago-jejunal anastomotic leakage, that may be avoidable or influ enced therapeutically. Patients and Methods: The study design was retr ospective involving 838 patients with total gastrectomy for gastric ca ncer from;he years 1973-1993. In 134 cases leakage of the esophago-jej unostomy occurred. The relative risk for the development of leakage as sociated with individual parameters was determined by comparing the da ta from 704 patients without leakage to the data from 134 patients pre senting with this complication. For a subgroup of 86 patients with ana stomotic leakage microbiological data of swabs taken from the anastomo ses were available, which were evaluated with respect to potentially p athogenic bacilli. Results: The overall leakage rate of esophago-jejun al anastomoses was 15.9% (n = 134). The mortality rate during this tim e period amounted to 14.3%. Leakage was a most highly significant fact or for mortality (p = 0.0001). Significant risk factors for leakage of the esophago-jejunostomy were tumors of the cardia, splenectomy, a du ration of operating time of more than 5 hours and manual suture techni que compared to stapler anastomoses. Tumor unrelated associated diseas e, tumor stage and a history of other preexisting gastric diseases wer e not associated with an increased relative risk. At the lime of the i nitial clinical manifestation of leakage the following pathogenic baci lli could be isolated from leaking anastomoses with decreasing inciden ce: E. coli. S. aureus. Proteus mirabilis, Pseudomonas aeruginosa. Kle bsiella pneumoniae a.o. The bacterial spectrum has not changed during the observation period of 20 years. Summary: With the exception of the choice of suture techniques the identified clinical risk factors cann ot be avoided or influenced therapeutically due to a lack of potential ly curative treatment alternatives. In contrast potentially pathogenic bacilli associated with leakage can be prevented from coming in conta ct with anastomoses thereby preventing infection and leakage.