Overview of anastomotic fistula Anastomotic fistula is the most common serious morbidity after esophageal cancer surgery and the main cause of death. The factors of occurrence are complex, and various surgical methods cannot guarantee the absence of fistula. In recent years, with the improvement of esophageal surgical techniques and the accumulation of experience in perioperative management, especially the clinical application of anastomotic devices, the incidence of anastomotic fistula and mortality rate have been significantly reduced. Factors of anastomotic fistula The causes of anastomotic fistula are complex and multifactorial, most notably closely related to anastomotic technique and surgical operation. Other risk factors that should be taken into account are frequent and violent postoperative coughing, which causes changes in respiratory pressure to be transmitted to the digestive tract, resulting in dramatic pressure changes in the esophagus and gastric cavity, and the pull of the stomach’s own gravity due to swallowing large amounts of food and drink, both of which can cause the fragile and edematous anastomotic tissue to tear during the healing process and form Anastomotic fistula. 1, early fistula within 3 days after surgery, related to surgery, mostly due to poor anastomosis, poor local blood supply, anastomotic tension or application of anastomosis errors, the probability is 1-5% 2, medium-term fistula 4-14 days after surgery, about a week is the most common, the causes are more complex, such as anastomotic local suture infection, tissue cutting necrosis, postoperative pleural effusion is not treated in a timely manner, incomplete lung expansion The causes are complex, such as local suture infection of the anastomosis, necrosis of tissue cutting, untreated postoperative pleural effusion, incomplete lung expansion, poor tissue healing ability, severe and frequent coughing, chest and stomach expansion, impaired gastric emptying, and pulling of the anastomosis by the stomach’s own gravity. Late fistula occurs more than 14 days after surgery. Mostly due to secondary anastomotic fistula caused by local infection around the anastomosis or due to small anastomotic fistula opening, this is clinically confirmed late, accounting for about 10-20%.