Unraveling the risks: A systematic review of factors leading to esophagojejunal dehiscence after gastric cancer surgery.

[BACKGROUND] Despite major advances in gastric cancer surgery, esophagojejunal anastomotic leakage (EJAL) remains a life-threatening complication after total gastrectomy. Its management is controversial and challenging, encompassing conservative treatment, endoscopic therapy, and surgical reintervention. Given its clinical impact, identifying predictive risk factors is essential to reduce incidence, enable early diagnosis, and improve outcomes. This systematic review aims to evaluate risk factors associated with esophagojejunal anastomotic failure and to propose preventive strategies.

[METHODS] Two independent reviewers conducted a systematic electronic search of PubMed, Cochrane Central Register of Controlled Trials, Embase, and Google Scholar up to June 2024. Search terms included OR AND OR , combined with , , , and . The protocol was registered in PROSPERO (CRD42021261841).

[RESULTS] A total of 221 studies were identified. After removal of duplicates and irrelevant studies, 18 studies met inclusion criteria. No additional studies were identified through cross-referencing. Study selection is summarized in a PRISMA flow diagram.

[CONCLUSIONS] Preoperative, intraoperative, and postoperative risk factors for esophagojejunal anastomotic leakage were identified and analyzed. Comprehensive knowledge of these factors is crucial to guide preventive strategies and ultimately reduce the incidence of this severe complication.