University of Michigan Medical School, Ann Arbor, Michigan; Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
Ann Thorac Surg. 2018 Mar;105(3):865-870. doi: 10.1016/j.athoracsur.2017.08.061. Epub 2018 Jan 5.
Anastomotic leak after esophagectomy remains a significant source of morbidity and mortality. The gastrointestinal (GI) microbiome has been found to play a significant role in tumor oncogenesis and postoperative bowel anastomotic leak. We hypothesized that the GI microbiome could differentiate between esophageal cancer histologies and predict postoperative anastomotic leak.
A prospective study of esophagectomy patients was performed from May 2013 to August 2014, with the collection of oral saliva, intraoperative esophageal and gastric mucosa, and samples of postoperative infections (neck swab or sputum). The presence and level for each bacterial probe as end points were used to analyze correlations with tumor histology, tumor stage, and presence of postoperative complications by unequal variances t tests for multiple comparisons and principal coordinate analysis.
Esophagectomy was successful in 55 of 66 patients who were enrolled. Among those, the diagnosis was adenocarcinoma in 44 (80%) squamous cell carcinoma in (13%), and benign disease in 4 (7%). The 30-day mortality was 1.8% (1 of 55). Complications included anastomotic leak requiring local drainage in 18% (10 of 55) and postoperative pneumonia in 2% (1 of 55). No correlation was noted between GI microbiome flora and tumor histology or tumor stage. A significant difference (p = 0.015) was found when the variance in bacterial composition between the preoperative oral flora was compared with intraoperative gastric flora in patients who had a leak but not in patients with pneumonia.
Patients with anastomotic leaks had increased variance in their preoperative oral and gastric flora. Microbiome analysis could help identify patients at higher risk for leak after esophagectomy.
食管癌手术后吻合口漏仍然是发病率和死亡率的重要原因。胃肠道（GI）微生物群已被发现对肿瘤发生和术后肠吻合口漏有重要作用。我们假设 GI 微生物群可以区分食管癌的组织学并预测术后吻合口漏。
对 2013 年 5 月至 2014 年 8 月接受食管癌切除术的患者进行了前瞻性研究，收集了口腔唾液、术中食管和胃黏膜以及术后感染（颈部拭子或痰液）样本。以每个细菌探针的存在和水平为终点，通过不等方差 t 检验和主坐标分析，分析与肿瘤组织学、肿瘤分期和术后并发症之间的相关性。
成功进行了 66 名入组患者中的 55 例食管癌切除术。其中，诊断为腺癌 44 例（80%），鳞状细胞癌 7 例（13%），良性疾病 4 例（7%）。30 天死亡率为 1.8%（55 例中的 1 例）。并发症包括吻合口漏需要局部引流 18%（55 例中的 10 例）和术后肺炎 2%（55 例中的 1 例）。GI 微生物群菌群与肿瘤组织学或肿瘤分期之间无相关性。在发生吻合口漏的患者中，术前口腔菌群与术中胃内菌群之间的细菌组成方差存在显著差异（p=0.015），但在发生肺炎的患者中则无差异。
吻合口漏患者的术前口腔和胃内菌群差异增大。微生物组分析有助于识别食管癌术后漏的高风险患者。
