FA01.02：微创食管癌切除术术后并发症对长期生存的影响：一项回顾性多中心队列研究

FA01.02: THE EFFECT OF POSTOPERATIVE COMPLICATIONS AFTER MIE ON LONG-TERM SURVIVAL: A RETROSPECTIVE, MULTI-CENTER COHORT STUDY.

作者信息

Fransen Laura, Berkelmans Gijs, Asti Emanuele, Van Berge Henegouwen Mark, Berlth Felix, Bonavina Luigi, Brown Andrew, Bruns Christiane, Gisbertz Suzanne, Grimminger Peter, Gutschow Christian, Hölscher Arnulf, Kauppi Juha, Lagarde Sjoerd M, Mercer Stuart, Moons Johnny, Nafteux Philippe, Nilsson Magnus, Palazzo Francesco, Pattyn Piet, Philippron Annouck, Raptis Dimitri, Räsänen Jari, Rosato Ernest, Rouvelas Ioannis, Schmidt Henner, Schneider Paul, Schröder Wolfgang, Wijnhoven Bas P L, Grard A P, Luyer Misha

机构信息

Catharina Hospital, Eindhoven/NETHERLANDS.

IRCCS Policlinico San Donato, University of Milan, Milan/ITALY.

出版信息

Dis Esophagus. 2018 Sep 1;31(13):1. doi: 10.1093/dote/doy089.FA01.02.

DOI:10.1093/dote/doy089.FA01.02

PMID:30219910

Abstract

BACKGROUND

Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esophagectomy (MIE) has been shown to be associated with a reduced postoperative morbidity. In this study, the influence of complications on long-term survival for patients with esophageal cancer undergoing a MIE were investigated.

METHODS

Data was collected from the EsoBenchmark database, a collaboration of 13 high-volume centers routinely performing MIE. Patients were included in this database from June 1, 2011 until May 31, 2016. Complications were scored according to the Clavien-Dindo (CD) classification for surgical complications. Major complications were defined as a CD grade ≥ 3. The data were corrected for 90-day mortality to correct for the short-term effect of postoperative complications on mortality. Overall survival was analyzed using the Kaplan Meier, log rank- and (uni- and multivariable) Cox-regression analyses.

RESULTS

A total of 926 patients were eligible for analysis. Mean follow-up time was 30.8 months (SD 17.9). Complications occurred in 543 patients (59.2%) of which 39.3% had a major complication. Anastomotic leakage (AL) occurred in 135 patients (14.5%) of which 9.2% needed an intervention (CD grade ≥ 3). A significant worse long-term survival was observed in patients with any AL (HR 1.73, 95% CI 1.29-2.32, P < 0.001) and for patients with AL CD grade ≥3 (HR 1.86, 95% CI 1.32-2.63, P < 0.001). Major cardiac complications occurred in 18 patients (1.9%) and were related to a decreased long-term survival (HR 2.72, 95% CI 1.38-5.35, p 0.004). For all other complications, no significant influence on long-term survival was found.

CONCLUSION

The occurrence and severity of anastomotic leakage and cardiac complications after MIE negatively affect long-term survival of esophageal cancer patients.

DISCLOSURE

All authors have declared no conflicts of interest.

摘要

背景

食管癌切除术术后发病率较高。并发症会导致短期生存率降低，然而这些并发症对长期生存的影响仍不清楚。大多数已开展的研究规模较小，是单中心队列研究系列，结果尚无定论或相互矛盾。微创食管癌切除术（MIE）已被证明与术后发病率降低相关。在本研究中，调查了并发症对接受MIE的食管癌患者长期生存的影响。

方法

数据收集自EsoBenchmark数据库，该数据库由13个常规进行MIE的高容量中心合作建立。2011年6月1日至2016年5月31日期间的患者被纳入该数据库。根据手术并发症的Clavien-Dindo（CD）分类对并发症进行评分。主要并发症定义为CD分级≥3级。对数据进行90天死亡率校正，以校正术后并发症对死亡率的短期影响。使用Kaplan Meier、对数秩和（单变量和多变量）Cox回归分析来分析总生存期。

结果

共有926例患者符合分析条件。平均随访时间为30.8个月（标准差17.9）。543例患者（59.2%）发生并发症，其中39.3%发生主要并发症。135例患者（14.5%）发生吻合口漏（AL），其中9.2%需要干预（CD分级≥3级）。任何AL患者的长期生存率均显著较差（风险比1.73，95%置信区间1.29 - 2.32，P < 0.001），AL CD分级≥3级的患者也是如此（风险比1.86，95%置信区间1.32 - 2.63，P < 0.001）。18例患者（1.9%）发生主要心脏并发症，与长期生存率降低相关（风险比2.72，95%置信区间1.38 - 5.35，P = 0.004）。对于所有其他并发症，未发现对长期生存有显著影响。