Juloori Aditya, Tucker Susan L, Komaki Ritsuko, Liao Zhongxing, Correa Arlene M, Swisher Stephen G, Hofstetter Wayne L, Lin Steven H
*Departments of Radiation Oncology, †Bioinformatics and Computational Biology, and ‡Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
J Thorac Oncol. 2014 Apr;9(4):534-40. doi: 10.1097/JTO.0000000000000100.
Postoperative morbidities, such as anastomotic leaks, are common after trimodality therapy (chemoradiation followed by surgery) for esophageal cancer. We investigated for factors associated with an increased incidence of anastomotic leaks.
Data from 285 esophageal cancer patients treated from 2000 to 2011 with trimodality therapy were analyzed. Anastomotic location relative to preoperative radiation field was assessed using postoperative computed tomographic imaging. Logistic regression was used to evaluate for factors associated with any or clinically relevant (CR) (≥ grade 2) leaks.
Overall anastomotic leak rate was 11% (31 of 285), and CR leak rate was 6% (17 of 285). Multivariable analysis identified body mass index (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.00-1.17; OR, 1.11, 95% CI, 1.01-1.22), three-field surgery (OR, 10.01; 95% CI, 3.83-26.21; OR, 4.83; 95% CI, 1.39-16.71), and within radiation field ("in-field") anastomosis (OR, 5.37; 95% CI, 2.21-13.04; OR, 8.63; 95% CI, 2.90-25.65) as independent predictors of both all grade and CR leaks, respectively. While patients with distal esophageal tumors and Ivor-Lewis surgery had the lowest incidence of all grade (6.5%) and CR leaks (4.2%), most of the leaks were associated with the anastomosis constructed within the field of radiation (in-field: 39% and 30% versus out-of-field: 2.6% and 1.0%, respectively, for total and CR leaks, p less than 0.0001, Fisher's exact test).
Esophagogastric anastomosis placed within the preoperative radiation field was a very strong predictor for anastomotic leaks in esophageal cancer patients treated with trimodality therapy, among other factors. Surgical planning should include a critical evaluation of the preoperative radiation fields to ensure proper anastomotic placement after chemoradiation therapy.
食管癌三联疗法(化疗放疗后手术)后,吻合口漏等术后并发症很常见。我们调查了与吻合口漏发生率增加相关的因素。
分析了2000年至2011年接受三联疗法治疗的285例食管癌患者的数据。使用术后计算机断层扫描成像评估吻合口相对于术前放疗野的位置。采用逻辑回归分析与任何程度或临床相关(CR)(≥2级)漏相关的因素。
总体吻合口漏率为11%(285例中的31例),CR漏率为6%(285例中的17例)。多变量分析确定体重指数(优势比[OR],1.09;95%置信区间[CI],1.00 - 1.17;OR,1.11,95%CI,1.01 - 1.22)、三野手术(OR,10.01;95%CI,3.83 - 26.21;OR,4.83;95%CI,1.39 - 16.71)以及放疗野内(“野内”)吻合(OR,5.37;95%CI,2.21 - 13.04;OR,8.63;95%CI,2.90 - 25.65)分别是所有级别漏和CR漏的独立预测因素。虽然食管远端肿瘤患者和采用艾弗·刘易斯手术的患者所有级别漏(6.5%)和CR漏(4.2%)的发生率最低,但大多数漏与放疗野内构建的吻合口相关(野内:总漏和CR漏分别为39%和\(30\%),而野外:分别为2.6%和1.0%,p<0.0001,Fisher精确检验)。
在接受三联疗法治疗的食管癌患者中,术前放疗野内的食管胃吻合是吻合口漏的一个非常强的预测因素,其他因素也有影响。手术规划应包括对术前放疗野进行严格评估,以确保放化疗后吻合口位置合适。