Impact of Sarcopenia on Healing after Stent Placement for Esophagojejunostomy Leaks Following Laparoscopic Gastrectomy for Gastric Cancer

Abstract

Introduction:

Esophagojejunal anastomotic leak is a serious complication following total gastrectomy for gastric cancer. Self-expanding metallic stents placed endoscopically offer a minimally invasive treatment option for managing this complication. While sarcopenia has been linked to adverse postoperative outcomes in various surgical fields, its impact on the success of endoscopic treatment for anastomotic leakage remains unclear. This study investigates whether sarcopenia predicts endoscopic treatment failure in patients with esophagojejunal leakage after total gastrectomy.

Materials and Methods:

A retrospective review was conducted of patients who underwent laparoscopic total gastrectomy and Roux-en-Y esophagojejunostomy due to gastric adenocarcinoma at our institution between January 2020 and May 2025. Among the 241 patients who underwent surgery during the specified period, 31 patients who developed esophagojejunal anastomotic leakage and were treated with self-expanding metallic stents were included in the study. Preoperative sarcopenia was assessed using the total psoas index, measured at the L3 vertebra level on computed tomography images. Patients were divided into two groups based on the presence of sarcopenia, and the clinical success of stent treatment was compared with postoperative outcomes.

Results:

The study cohort consisted of 31 patients with a median age of 59 years (interquartile range: 51–67). Sarcopenia was detected in 29% (n = 9) of the study population. The overall clinical success rate of stenting was 67.7%, and this rate was significantly lower in the sarcopenia group (33.3% versus 81.8%; P = .009). The length of hospital stay was significantly longer in sarcopenic patients (37.8 ± 21.3 days versus 25.2 ± 10.3 days; P = .033), but there was no statistically significant difference between the groups in terms of intensive care unit admission duration (5.89 ± 5.58 days versus 2.95 ± 3.08 days; P = .069).

Conclusions:

Preoperative sarcopenia is associated with lower clinical success rates in endoscopic stent treatment of esophagogastric anastomotic leakage after gastric cancer surgery.