Comment on “Risk Factors for Esophagojejunal Anastomotic Leakage after Total Gastrectomy”

Maejima et al. 1 The authors conducted a retrospective study to identify risk factors for esophago-jejunal anastomotic leakage (EJAL) in 309 patients who underwent total gastrectomy and Roux-en-Y esophago-jejunal anastomosis for gastric cancer.The study found that 23 patients (7.4%) experienced EJAL.Univariate analysis indicated that age, gender, diabetes mellitus, esophageal invasion, and blood loss were associated with EJAL.In multivariate analysis, age 68 years (odds ratio [OR]: 4.98, 95% confidence interval [CI]: 1.65-15.05),male gender (OR: 8.64, 95% CI: 1.07-70.05),presence of diabetes mellitus (OR: 5.18, 95% CI: 1.77-15.13),and blood loss 1,100 g (OR: 3.96, 95% CI: 1.46-10.74)were identified as independent risk factors.Bracale et al. 2 conducted a systematic review of 16 studies (42,489 cases in total) to identify risk factors for EJAL after total gastrectomy for gastric cancer.Multivariate analysis identified age, BMI, respiratory dysfunction, prognostic nutritional index (PNI), alcohol consumption, diabetes, chronic renal failure, and mixed histology as independent risk factors.For instance, patients with a BMI>25 exhibited a substantially elevated risk of EJAL (OR: 12.127, 95% CI: 2.652-72.933).Similarly, patients with a PNI<55 demonstrated a significant association with EJAL (OR: 0.208, 95% CI: 0.044).These findings suggest that BMI and PNI may serve as useful preoperative variables for predicting postoperative complications, including EJAL.Liu et al. 3 conducted a retrospective