Department of Surgery, Section for upper gastrointestinal and hepato-pancreato-biliary surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark.
J Gastrointest Surg. 2018 Apr;22(4):587-594. doi: 10.1007/s11605-017-3623-7. Epub 2017 Nov 13.
The objective of this study is to investigate the impact of ketorolac and other nonsteroidal anti-inflammatory drugs on anastomotic leakage after surgery for gastro-esophageal-junction cancer. Within the last two decades, the incidence of gastro-esophageal-junction cancer has increased in the western world and surgery is the curative treatment modality of choice. Anastomotic leakage is a feared complication of gastro-esophageal surgery, as it increases recurrence, morbidity, and mortality. Nonsteroidal anti-inflammatory drugs are widely used for postoperative pain relief. Nonsteroidal anti-inflammatory drugs have, however, in colorectal surgery, been shown to increase the risk of anastomotic leakage.
In a historical cohort study, we investigated the impact of nonsteroidal anti-inflammatory drugs on anastomotic leakage in 557 patients undergoing surgery for gastro-esophageal-junction cancer. Data were collected from a prospective maintained database, the Danish National Patient Registry, and patient medical records. Data were analyzed using univariate and multivariate statistical models and were stratified for theoretical confounders.
In univariate analysis, we did not observe any difference in age, gender, tobacco exposure, or comorbidity status between patients experiencing anastomotic leakage and those without. In multivariate analysis, gender, histology, and type of anastomosis proved to affect odds ratios for anastomotic leakage. After adjustment for possible confounders, we found an odds ratio of 6.05 (95% confidence interval 2.71; 13.5) for ketorolac use and of 5.24 (95% confidence interval 1.85; 14.8) for use of other nonsteroidal anti-inflammatory drugs for anastomotic leakage during the first seven postoperative days.
In the present study, we found a strong association between the postoperative use of ketorolac and other nonsteroidal anti-inflammatory drugs and the risk for anastomotic leakage after surgery for gastro-esophageal-junction cancers.
本研究旨在探讨酮咯酸和其他非甾体抗炎药对胃食管交界癌手术后吻合口漏的影响。在过去的二十年中，西方世界胃食管交界癌的发病率有所增加，手术是首选的治愈性治疗方法。吻合口漏是胃食管手术的一种可怕的并发症，因为它会增加复发、发病率和死亡率。非甾体抗炎药被广泛用于术后止痛。然而，在结直肠手术中，非甾体抗炎药已被证明会增加吻合口漏的风险。
在一项历史队列研究中，我们调查了 557 例胃食管交界癌患者手术后非甾体抗炎药对吻合口漏的影响。数据来自一个前瞻性维护的数据库、丹麦国家患者登记处和患者病历。使用单变量和多变量统计模型以及理论混杂因素进行分层分析数据。
在单变量分析中，我们没有观察到吻合口漏患者和无吻合口漏患者在年龄、性别、吸烟状况或合并症状态方面有任何差异。在多变量分析中，性别、组织学和吻合类型被证明影响吻合口漏的比值比。在调整可能的混杂因素后，我们发现酮咯酸使用的比值比为 6.05（95%置信区间 2.71；13.5），其他非甾体抗炎药在术后 7 天内使用的比值比为 5.24（95%置信区间 1.85；14.8）。
在本研究中，我们发现手术后使用酮咯酸和其他非甾体抗炎药与胃食管交界癌手术后吻合口漏的风险之间存在很强的关联。
