First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
251 VA and Hellenic Air Force Hospital, Athens, Greece.
Br J Surg. 2019 Apr;106(5):534-547. doi: 10.1002/bjs.11128.
BACKGROUND: Oesophagectomy is associated with high morbidity and mortality rates. New-onset atrial fibrillation (AF) is a frequent complication following oesophagectomy. Several studies have explored whether new-onset AF is associated with adverse events after oesophagectomy. METHODS: This review was performed according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 25 November 2018. A meta-analysis was conducted with the use of random-effects modelling. The I statistic was used to assess for heterogeneity. RESULTS: In total, 53 studies including 9087 patients were eligible for analysis. The overall incidence of postoperative AF was 16·5 per cent. Coronary artery disease and hypertension were associated with AF, whereas diabetes, smoking and chronic obstructive pulmonary disease were not. Patients with AF had a significantly higher risk of overall postoperative adverse events than those without fibrillation (odds ratio (OR) 5·50, 95 per cent c.i. 3·51 to 8·30), including 30-day mortality (OR 2·49, 1·70 to 3·64), anastomotic leak (OR 2·65, 1·53 to 4·59) and pneumonia (OR 3·42, 2·39 to 4·90). CONCLUSION: Postoperative AF is frequently observed in patients undergoing oesophagectomy for cancer. It is associated with an increased risk of death and postoperative complications.
背景:食管癌切除术的发病率和死亡率都很高。新发心房颤动(AF)是食管癌切除术后的常见并发症。几项研究探讨了新发 AF 是否与食管癌切除术后的不良事件有关。
方法:本综述按照 PRISMA 指南进行。通过对 PubMed、Scopus 和 Cochrane CENTRAL 数据库进行检索,截至 2018 年 11 月 25 日,确定了符合条件的研究。使用随机效应模型进行荟萃分析。使用 I 统计量评估异质性。
结果:共有 53 项研究,包括 9087 例患者,符合分析条件。术后 AF 的总体发生率为 16.5%。冠心病和高血压与 AF 相关,而糖尿病、吸烟和慢性阻塞性肺疾病则没有。AF 患者的总体术后不良事件风险显著高于无房颤患者(比值比 5.50,95%置信区间 3.51 至 8.30),包括 30 天死亡率(比值比 2.49,1.70 至 3.64)、吻合口漏(比值比 2.65,1.53 至 4.59)和肺炎(比值比 3.42,2.39 至 4.90)。
结论:癌症患者行食管癌切除术常发生术后 AF。它与死亡和术后并发症的风险增加有关。
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