PD02.01. The Association Between the Gastro-Esophageal Micro-Organisms and Anastomotic Leakage in Esophageal Cancer Surgery: A Prospective Observational Cohort Study

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ID: 326019
2026
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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background Anastomotic leakage (AL) following esophagectomy with gastric conduit reconstruction is a severe complication. The influence of the gastric and esophageal microbiome on anastomotic leakage after esophageal cancer surgery is yet to be determined. The aim of this study was to evaluate the gastro-esophageal micro-organisms and its association with anastomotic leakage. Methods This prospective observational cohort study was conducted between June 2020 and September 2025. Patients undergoing elective esophagectomy with gastric conduit reconstruction for esophageal adenocarcinoma or squamous cell carcinoma (cT1N+M0 or cT2–4aN0–3M0) were eligible. Patients were included if intraoperative esophageal and gastric-conduit culture swabs were obtained, and microbiological determination was conducted. The primary outcome was the bacterial and yeast spectrum in AL-positive versus AL-negative patients. Secondary outcomes included AL severity, treatment-susceptibility profiling, and postoperative survival. Multivariable logistic regression was performed, correcting for established confounders: diabetes mellitus diagnosis, and location of anastomosis. Sample size calculations indicated a total of 236 patients to be included to achieve the minimum number of AL events (n=36). Results In total, 250 patients were included, of which 39 (16%) developed AL. The cohort was predominantly male (77%) with a median age of 68 years [IQR 62–73], and most had cT3 (76%) cN0–1 (78%) staged adenocarcinoma (87%). Minimally invasive (89%), transthoracic esophagectomy (98%) Ivor Lewis (83%) was the most performed procedure. Other baseline, tumor, treatment, and surgical characteristics were comparable between AL-positive and AL-negative patients. Microbiological assessment showed positive micro-organism cultures in 199/250 patients (80%). Positive yeast cultures in the gastric conduit were significantly associated with AL (adjusted OR 3.74; 95% CI 1.39–10.44; p = 0.008). Candida albicans was the most frequently isolated yeast, present in 51/71 (72%) positive gastric conduit swabs; 75% of the gastric conduit yeast cultures were sensitive to standard-dose fluconazole. No association was found for other micro-organisms, micro-organism load, nor with severity of AL or survival. Conclusion Intraoperative gastric conduit yeast cultures were associated with increased AL incidence. Future research should determine whether prophylactic or culture based antifungal treatment reduces the anastomotic leakage rate.
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Authors Hidde Overtoom, Serhat Çiftci, Jarne van Hattum, Wietse Eshuis, Mark van Berge Henegouwen, Suzanne Gisbertz
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.079
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.079/70760317/doag077.079.pdf
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