[Results] Sixty-two patients died within 30 days after operation, with a postoperative mortality of 1.38%. Main causes of postoperative death were multiple organ failure(26 cases,41.9%),toxic shock(9 cases,14.5%), acute renal failure(4 cases,6.5%), and anastomotic leakage(3 cases,4.8%).
TME was a risk factor for postoperative anastomotic leak according to the results of all included studies and prospective study analyses,hut no difference between TME group and CRS group had been found [OR 1.24(95%CI 0.84～1.83,P=0.29) OR 1.98(95%CI 0.85～4.61,P=0.11)].
The postoperative anastomotic leakage is the most severe complication and the principal cause of death after resection of esophageal carcinoma.
Especially, anastomosis above the aorta arch is accompanied by high incidence of anastomotic leakage usually with fatal prognosis.
Repeat surgery for primary repair of complex bile leaks is difficult and can be complicated by anastomotic leakage and biliary stricture formation.
In an analysis of the recent literature the main risk factors are: tension of the ileal pouch-anal anastomosis, anastomotic leakage, lack of protective ileostomy, preoperatively undiagnosed Crohn's disease and the experience of the surgeon.
One patient died because of an anastomotic leakage.
Nonfatal postoperative complications consisted of respiratory distress in 33 patients, recurrent nerve palsy in 10, anastomotic fistula in 10 (cervical in 8 and intrathoracic in 2) and anastomotic stenosis in 18 patients.
The esogastric anastomotic fistula,occurring after the replacement of esophagus by the stomach, is a post-operative complication always feared and awaited.
Six patients developed an anastomotic fistula (21% with the ITRvs 22% with the RSR;P not significant), whereas an anastomotic stenosis occurred in 13 patients (67% with the RSR, and 37% with the ITR;P>amp;lt;0.07).
Another developed an anastomotic fistula, which was treated conservatively with a thoracotomy and resolved.
In the fourth patient an anastomotic fistula into the vagina was diagnosed 3 months after the primary operation.