良性疾病行食管切除术是否良性？

Is Esophagectomy for Benign Conditions Benign?

机构信息

Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan.

Division of Thoracic Surgery, Henry Ford Health System/Wayne State University, Detroit, Michigan.

出版信息

Ann Thorac Surg. 2018 Aug;106(2):368-374. doi: 10.1016/j.athoracsur.2018.03.047. Epub 2018 Apr 22.

DOI:10.1016/j.athoracsur.2018.03.047

PMID:29689236

Abstract

BACKGROUND

Outcomes data on esophagectomy performed for benign conditions is scarce. Using the National Surgical Quality Improvement Program database, we sought to analyze outcomes of esophagectomy performed for benign conditions.

METHODS

The National Surgical Quality Improvement Program database was queried for all esophagectomies performed from 2005 to 2015. Outcomes for benign conditions were analyzed and compared with outcomes for malignant conditions.

RESULTS

Esophagectomy was performed in 7,477 patients during the study period. Of those, 6,762 underwent esophagectomy for malignant conditions and 715 for benign conditions. For patients with benign conditions, reconstruction was performed using gastric conduit in 631 and colon/intestine in 84. The anastomosis was intrathoracic in 420 and cervical in 295. Benign esophagectomies were more likely to be emergent (10.1% vs 0.4%, p < 0.001). In addition, these patients had a longer hospital length of stay (17.2 days vs 14.5 days, p < 0.001) and higher occurrence of Clavien-Dindo grade IV complications (25% vs 20%, p = 0.003). Mortality was similar at 4%. In patients with benign conditions, reconstruction with colon/intestine had higher occurrence of Clavien-Dindo Grade IV complications (37% vs 23%, p = 0.006), surgical wound infections (33% vs 16%, p < 0.001), and death (10% vs 4%, p = 0.017) compared with gastric reconstruction. Site of anastomosis did not affect outcomes.

CONCLUSIONS

Benign esophagectomies are associated with significant morbidity. Although the site of the anastomosis does not alter outcomes, use of colon/intestine conduit should be pursued with caution.

摘要

背景

关于良性疾病行食管切除术的结果数据很少。本研究使用国家外科质量改进计划数据库，旨在分析良性疾病行食管切除术的结果。

方法

从 2005 年至 2015 年，国家外科质量改进计划数据库中检索所有行食管切除术的患者。分析并比较了良性疾病与恶性疾病的结果。

结果

研究期间共进行了 7477 例食管切除术，其中 6762 例患者因恶性疾病行食管切除术，715 例患者因良性疾病行食管切除术。良性疾病患者中，631 例行胃管重建，84 例行结肠/肠重建。吻合口位于胸腔内 420 例，颈部 295 例。良性食管切除术更可能是紧急手术（10.1% vs 0.4%，p < 0.001）。此外，这些患者的住院时间更长（17.2 天 vs 14.5 天，p < 0.001），且更易发生四级 Clavien-Dindo 并发症（25% vs 20%，p = 0.003）。死亡率相似，为 4%。在良性疾病患者中，结肠/肠重建的四级 Clavien-Dindo 并发症发生率（37% vs 23%，p = 0.006）、手术伤口感染率（33% vs 16%，p < 0.001）和死亡率（10% vs 4%，p = 0.017）均高于胃重建。吻合口部位不影响结果。