Blood Transfusion and Cervical Anastomotic Leakage in Esophageal Reconstructive Surgery

Introduction: Esophageal reconstruction is associated with significant blood loss and blood transfusion rates. Blood transfusion is a quick method of correction of anemia and rapid restoration of intravascular volume. However, concerns exist about the side effects of blood transfusion on the anastomotic complications. This prospective study aimed to report the impact of intraoperative blood transfusion on cervical anastomotic leak rate in esophageal reconstructive surgery Patients and methods: From 2006 to 2014, 85 the left isoperistaltic colon grafts based on the left colonic vessels were performed. There were 71 females and 14 males. The mean age of patients was 25 years. The mean preoperative haemoglobin (Hb) was 11.24 ± 9.23 g/dl. Operative blood loss 500 ml was used as threshold for ABT. The oesophagocolique anastomotic integrity was assessed by barium study. Impact of intraoperative allogeneic blood transfusion on the cervical anastomosis rate was studied. Statistical analyses were performed using Student’s t-test or the chi-square test. The multivariate analysis was performed by SPSS 11.0 for Windows (SPSS, Chicago, IL, USA). Results: The median operative duration was 3 hours. The median hospital stay was 14 days. The mortality rate was 2.4%. Graft necrosis occurred in two patients. Fifty patients received intra-operative allogeneic blood transfusion. Twenty seven patients were developed a cervical leak. There were 23 females and 4 males. Leak was occurred in 22 patients who received intraoperative ABT. The complete spontaneous healing of leak was obtained in all patients after a median delay of 7 days. The result of the univariate and multivariate analysis revealed that the intra-operative allogeneic blood transfusion was a predictive factor of cervical leak. Conclusion: The correction of preoperative anemia, meticulous surgical dissection, good haemostasis and the respect of the guidelines of blood transfusion may reduce intraoperative blood transfusion and related surgical site infection.