Giugliano D N, Berger A C, Meidl H, Pucci M J, Rosato E L, Keith S W, Evans N R, Palazzo F
Department of Surgery.
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Dis Esophagus. 2017 Apr 1;30(4):1-8. doi: 10.1093/dote/dow034.
Intraoperative pyloric procedures are often performed during esophagectomies to reduce the rates of gastric conduit dysfunction. They include pyloroplasty (PP), pyloromyotomy (PM), and pylorus botulinum toxin type-A injections (BI). Despite these procedures, patients frequently warrant further endoscopic interventions. The aim of this study is to compare intraoperative pyloric procedures and the rates of postoperative endoscopic interventions following minimally invasive esophagectomy (MIE). We identified patients who underwent MIE for esophageal carcinoma and grouped them as 'None' (no intervention), 'PP', 'PM', or 'BI' based on intraoperative pyloric procedure type. The rates of endoscopic interventions for the first six postoperative months were compared. To adjust for variability due to MIE type, the rates of >1 interventions were compared using a zero-inflated Poisson regression analysis. Significance was established at P < 0.05. There were 146 patients who underwent an MIE for esophageal cancer from 2008 to 2015; 77.4% were three-hole MIE, and 22.6% were Ivor- Lewis MIE. BI was most frequent in Ivor-Lewis patients (63.5%), while PP was most frequent (46.9%) in three-hole patients. Postoperative endoscopic interventions occurred in 38 patients (26.0%). The BI group had the highest percentage of patients requiring a postoperative intervention (n = 13, 31.7%). After adjusting for higher rates of interventions in three-hole MIE patients, the BI and None groups had the lowest rates of >1 postoperative interventions. Our data did not show superiority of any pyloric intervention in preventing endoscopic interventions. The patients who received BI to the pylorus demonstrated a trend toward a greater likelihood of having a postoperative intervention. However when adjusted for type of MIE, the BI and None groups had lower rates of subsequent multiple interventions. Further research is needed to determine if the choice of intraoperative pyloric procedure type significantly affects quality of life, morbidity, and overall prognosis in these patients.
术中幽门手术常在食管切除术期间进行，以降低胃代食管功能障碍的发生率。这些手术包括幽门成形术（PP）、幽门肌切开术（PM）和A型肉毒杆菌毒素幽门注射（BI）。尽管采取了这些手术，但患者仍常常需要进一步的内镜干预。本研究的目的是比较术中幽门手术及微创食管切除术（MIE）后内镜干预的发生率。我们确定了因食管癌接受MIE的患者，并根据术中幽门手术类型将他们分为“无”（未干预）、“PP”、“PM”或“BI”组。比较术后前六个月的内镜干预发生率。为了校正因MIE类型导致的变异性，使用零膨胀泊松回归分析比较了超过1次干预的发生率。P < 0.05时具有统计学意义。2008年至2015年有146例患者因食管癌接受了MIE；77.4%为三孔MIE，22.6%为艾弗-刘易斯MIE。BI在艾弗-刘易斯患者中最常见（63.5%），而PP在三孔患者中最常见（46.9%）。38例患者（26.0%）发生了术后内镜干预。BI组需要术后干预的患者百分比最高（n = 13，31.7%）。在校正三孔MIE患者较高的干预率后，BI组和无干预组术后超过1次干预的发生率最低。我们的数据未显示任何幽门干预在预防内镜干预方面具有优越性。接受幽门BI治疗的患者术后干预的可能性有增大趋势。然而，校正MIE类型后，BI组和无干预组后续多次干预的发生率较低。需要进一步研究以确定术中幽门手术类型的选择是否会显著影响这些患者的生活质量、发病率和总体预后。
