Interclavicular distance: a risk factor for anastomotic leakage following esophagectomy using retrosternal gastric conduit reconstruction

Introduction: Anastomotic leaks (AL) following esophagectomy are one of the most feared postoperative complications, especially in retrosternal route reconstruction, and various pieces of evidence have shown different anatomical features related to this catastrophic event. We aimed to define whether specific factors of thoracic inlet sizes can predict the development of leakage following esophagectomy. Methods: This was a cross-sectional study conducted at a single center on 94 consecutive patients who underwent thoracolaparoscopic esophagectomy using retrosternal gastric conduit reconstruction from March 2019 to December 2023. A preoperative CT scan was used to measure various anatomic dimensions of the thoracic inlet. Clinical factors associated with anastomotic leak were assessed, including thoracic inlet sizes. Results: AL occurred in 17 patients (18.1%), which caused a prolonged length of hospital stay (20.00 ± 8.62 nights versus 13.57 ± 4.67 nights, P = 0.008). On univariate analysis, several dimensions of the thoracic inlet were statistically significant risk factors associated with AL. However, after multivariate analysis, only the interclavicular distance (ICD) was an independent prognostic factor for AL [OR = −0.191, 95% CI (−0.353)–(−0.029), P = 0.021]. The incidence of AL increased significantly from 13.8% to 42.9% when the ICD < 24 mm ( P = 0.009). Conclusions: Following retrosternal reconstruction, the ICD was identified as the independent risk factor for AL. Retrosternal route should be avoided for patients with ICD < 24 mm. A future large-scale study is needed to generalize these findings to broader patient populations.