Factors associated with anastomotic leak following gastrectomy for gastric adenocarcinoma and its effect on long-term outcomes.

Objectives: Gastrectomy for cancer is a technically demanding surgery and anastomotic leak is an important complication of this surgery. This study aimed to identify the factors associated with anastomotic leak following gastrectomy in gastric cancer patients and its long-term effect on outcomes. Material and Methods: This is an ambispective study of 181 patients who underwent curative gastrectomy for gastric adenocarcinoma over 13 years, at our institution. Groups with and without anastomotic leak were compared using the Mann-Whitney U test (continuous variables) and Chi-square test (categorical variables). A multivariable analysis was performed to determine the factors associated with anastomotic leak. Results: Out of the 181 patients who underwent curative gastrectomy, 12 (6.6%) patients experienced anastomotic leak. A multivariable analysis revealed that younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associating factors for anastomotic leak. During a median follow-up of 34 months (ranging from 12 to 130), it was observed that 25 (18.3%) patients developed anastomotic stenosis, but it was not related to anastomotic leak. The incidence of post-operative pulmonary complications, administration of adjuvant therapy, recurrence rates, and mortality due to anastomotic leak did not significantly change. Moreover, neoadjuvant therapy did not increase the incidence of anastomotic leaks. Conclusion: Factors like younger age, presence of comorbidities, hypoalbuminemia, tumor location in the proximal stomach, type of reconstruction, and positive margin status were associated with increased risk of anastomotic leak, which needs further studies to validate the findings. Thus, preoperative optimization and resection with adequate margins may be of utmost importance in preventing anastomotic leaks.