Early diagnosis of anastomotic leakage after gastric cancer surgery

Abstract Background Anastomotic leakage is a life-threatening postoperative complication after gastric cancer surgery. Previous studies have not produced convincing results for the early diagnosis of anastomotic leakage. This study thoroughly investigated the clinical factors and postoperative computed tomography (CT) findings that could facilitate the early diagnosis of anastomotic leak. Methods Gastric cancer patients who underwent curative gastrectomy and had a CT examination after surgery were included in this study. Propensity score (PS) matching generated 70 cases (35 cases of anastomotic leakage and 35 cases of no anastomotic leak) among 210 eligible cases. Univariate and multivariate analyses were used to identify the predictive postoperative variables. A nomogram was developed for prospective prediction. Results The logistic regression analysis revealed that the neutrophilia (NE ≥85.8%) on postoperative day 1st to day 3rd (POD 1-3), fever (body temperature (T) ≥38.5°C) on postoperative day 4th to day 7th (POD 4-7), and extraluminal gas at the anastomosis site (on CT examination), were the independent predictive factors for an anastomotic leakage (p Conclusions Postoperative CT examination is beneficial for the early diagnosis of anastomotic leakage in patients with consistent neutrophilia and fever(T≥38.5°C) during the postoperative day 4th to day 7th. Extraluminal gas at the anastomosis site on postoperative CT examination is highly suggestive of anastomotic leakage.