Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Ann Surg. 2012 Apr;255(4):658-66. doi: 10.1097/SLA.0b013e3182480a6a.
This review summarizes reporting of complications of esophageal cancer surgery.
Accurate assessment of morbidity and mortality after surgery for cancer is essential to compare centers, allow data synthesis, and inform clinical decision-making. A lack of defined standards may distort clinically relevant treatment effects.
Systematic literature searches identified articles published between 2005 and 2009 reporting morbidity and mortality after esophagectomy for cancer. Data were analyzed for frequency of complication reporting and to check whether outcomes were defined and classified for severity and whether a validated system for grading complications was used. Information about reporting outcomes adjusting for baseline risk factors was collated, and a descriptive summary of the results of included outcomes was undertaken.
Of 3458 abstracts, 224 full papers were reviewed and 122 were included (17 randomized trials and 105 observational studies), reporting outcomes of 57,299 esophagectomies. No single complication was reported in all papers, and 60 (60.6%) did not define any of the measured complications. Anastomotic leak was the most commonly reported morbidity, assessed in 80 (80.1%) articles, defined in 28 (28.3%), but 22 different descriptions were used. Five papers (5.1%) categorized morbidity with a validated grading system. One hundred fifteen papers reported postoperative mortality rates, 25 defining the term using 10 different definitions. In-hospital mortality was the most commonly used term for postoperative death, with 6 different interpretations of this phrase. Eighteen papers adjusted outcomes for baseline risk factors and 60 presented baseline measures of comorbidity.
Outcome reporting after esophageal cancer surgery is heterogeneous and inconsistent, and it lacks methodological rigor. A consensus approach to reporting clinical outcomes should be considered, and at the minimum it is recommended that a "core outcome set" is defined and used in all studies reporting outcomes of esophageal cancer surgery. This will allow meaningful cross study comparisons and analyses to evaluate surgery.
本综述总结了食管癌手术并发症的报告情况。
准确评估癌症手术后的发病率和死亡率对于比较中心、允许数据综合以及为临床决策提供信息至关重要。缺乏明确的标准可能会扭曲与临床相关的治疗效果。
系统文献检索确定了 2005 年至 2009 年间发表的报告癌症手术后发病率和死亡率的文章。分析了并发症报告的频率，检查结果是否定义和分类为严重程度，以及是否使用了验证的并发症分级系统。整理了关于根据基线风险因素调整报告结果的信息，并对纳入结果的结果进行了描述性总结。
在 3458 篇摘要中，有 224 篇全文进行了审查，其中 122 篇被纳入（17 项随机试验和 105 项观察性研究），共报告了 57299 例食管切除术的结果。没有一篇文章报告了所有并发症，其中 60 篇（60.6%）没有定义任何测量的并发症。吻合口漏是最常见的报告发病率，在 80 篇（80.1%）文章中评估，在 28 篇（28.3%）中定义，但使用了 22 种不同的描述。有 5 篇（5.1%）文章使用验证的分级系统对发病率进行分类。有 115 篇文章报告了术后死亡率，其中 25 篇使用 10 种不同的定义定义了这个术语。住院期间死亡率是术后死亡最常用的术语，有 6 种不同的解释。有 18 篇文章根据基线风险因素调整了结果，有 60 篇文章报告了基线合并症的指标。
食管癌手术后的结果报告存在异质性和不一致性，缺乏方法学严谨性。应该考虑采用报告临床结果的共识方法，至少建议在报告食管癌手术后结果的所有研究中定义和使用“核心结果集”。这将允许对手术进行有意义的跨研究比较和分析。
