Speicher James E, Gunn Tyler M, Rossi Nicholas P, Iannettoni Mark D
Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, North Carolina.
Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
Semin Thorac Cardiovasc Surg. 2018;30(4):476-484. doi: 10.1053/j.semtcvs.2018.08.004. Epub 2018 Sep 4.
The cervical anastomotic leak is a major complication of transhiatal esophagectomy and results in chronic strictures in up to half of patients. A change in postoperative protocol to delaying initiation of oral intake was made with the goal of reducing anastomotic leak rate and associated sequelae. A postoperative protocol change was applied to all patients undergoing elective transhiatal esophagectomy. Rate of anastomotic leak and anastomotic stricture, defined as defect in the esophagogastric anastomosis and narrowing of the anastomosis, respectively, were compared between pre- and post-change groups. Between 2004 and 2013, 203 patients underwent transhiatal esophagectomy with cervical anastomosis. Historically, oral intake was resumed on postoperative day 3, and during the course of the study, a change was made to the protocol to delay oral intake until 15 days postoperatively. Eighty-three patients were in the early oral feeding group (postoperative day 3), and 120 were in the delayed oral intake group (postoperative day 15). There was a statistically significant decrease in the rate of anastomotic leak from 14.5% to 4.2% between the early and delayed intake groups, respectively (P = 0.0089). There was also a trend (P = 0.05) towards a lower rate of anastomotic stricture in all patients in the delayed intake group (15.8%) compared with those in the early feeding group (27.7%). By increasing the time to postoperative oral feeding, we have noted an associated improvement in both immediate and long-term outcomes of elective transhiatal esophagectomy patients.
颈部吻合口漏是经胸段食管切除术的主要并发症，多达半数的患者会出现慢性狭窄。为降低吻合口漏发生率及相关后遗症，术后方案改为延迟开始经口进食。术后方案的改变应用于所有接受择期经胸段食管切除术的患者。分别比较改变前后两组患者吻合口漏和吻合口狭窄的发生率，其中吻合口漏定义为食管胃吻合口处出现缺损，吻合口狭窄定义为吻合口变窄。2004年至2013年期间，203例患者接受了经胸段食管切除术并进行颈部吻合。以往术后第3天开始经口进食，在研究过程中，方案改为将经口进食延迟至术后15天。83例患者属于早期经口进食组（术后第3天），120例患者属于延迟经口进食组（术后第15天）。早期和延迟进食组的吻合口漏发生率分别从14.5%降至4.2%，差异具有统计学意义（P = 0.0089）。延迟进食组所有患者的吻合口狭窄发生率（15.8%）与早期进食组（27.7%）相比也有降低趋势（P = 0.05）。通过增加术后经口进食的时间，我们注意到择期经胸段食管切除术患者的近期和远期结局均有相关改善。
