Department of General, Visceral and Cancer Surgery, University of Cologne, Germany.
Department of Radiology, University of Cologne, Germany.
Dis Esophagus. 2019 Jul 1;32(7). doi: 10.1093/dote/doy107.
Transthoracic esophagectomy with gastric tube formation is the surgical treatment of choice for esophageal cancer. The surgical reconstruction induces changes of gastric microcirculation, which are recognized as potential risk factors of anastomotic leak. This prospective observational study investigates the association of celiac trunk (TC) stenosis with postoperative anastomotic leak. One hundred fifty-four consecutive patients with esophageal cancer scheduled for Ivor-Lewis esophagectomy were included. Preoperative staging computed tomography (CT) was used to identify TC stenosis. Any narrowing of the lumen due to atherosclerotic changes was classified as stenosis. Percentage of stenotic changes was calculated using the North American Symptomatic Carotid Endarterectomy Trial formula. Multivariable analysis was used to identify possible risk factors for leak. The overall incidence of TC stenosis was 40.9%. Anastomotic leak was identified in 15 patients (9.7%). Incidence of anastomotic leak in patients with stenosis was 19.4% compared to 2.3% in patients without stenosis. Incidence of stenosis in patients with leak was 86.7% (13 of 15 patients) and significantly higher than 38.8% (54 of 139 patients) in patients without leak (P < 0.001). There was a significant difference in median degree of TC stenosis (50.0% vs 39.4%; P = 0.032) in patients with and without leak. In the multivariable model, TC stenosis was an independent risk factor for anastomotic leak (odds ratio: 5.98, 95% CI: 1.58-22.61). TC stenosis is associated with postoperative anastomotic leak after Ivor-Lewis esophagectomy. Routine assessment of TC for possible stenosis is recommended to identify patients at risk.
经胸食管切除术和管状胃成形术是治疗食管癌的首选手术方法。手术重建会引起胃微循环的变化，这些变化被认为是吻合口漏的潜在危险因素。本前瞻性观察研究调查了腹腔干（TC）狭窄与术后吻合口漏的关系。纳入了 154 例连续接受 Ivor-Lewis 食管癌切除术的患者。术前分期 CT 用于识别 TC 狭窄。由于动脉粥样硬化改变导致的管腔任何狭窄均被分类为狭窄。狭窄变化的百分比使用北美症状性颈动脉内膜切除术试验公式计算。多变量分析用于确定吻合口漏的可能危险因素。TC 狭窄的总发生率为 40.9%。吻合口漏的发生率为 15 例（9.7%）。狭窄患者的吻合口漏发生率为 19.4%，而无狭窄患者的吻合口漏发生率为 2.3%。吻合口漏患者的狭窄发生率为 86.7%（13/15 例），明显高于无吻合口漏患者的 38.8%（54/139 例）（P < 0.001）。有吻合口漏和无吻合口漏患者的 TC 狭窄中位数程度存在显著差异（50.0% vs 39.4%；P = 0.032）。在多变量模型中，TC 狭窄是吻合口漏的独立危险因素（比值比：5.98，95%CI：1.58-22.61）。TC 狭窄与 Ivor-Lewis 食管切除术术后吻合口漏相关。建议常规评估 TC 是否存在狭窄，以识别有风险的患者。
