心肺合并症与食管癌术后并发症：一项欧洲多中心队列研究。
Cardiorespiratory Comorbidity and Postoperative Complications following Esophagectomy: a European Multicenter Cohort Study.
机构信息
Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
出版信息
Ann Surg Oncol. 2019 Sep;26(9):2864-2873. doi: 10.1245/s10434-019-07478-6. Epub 2019 Jun 10.
BACKGROUND
The impact of cardiorespiratory comorbidity on operative outcomes after esophagectomy remains controversial. This study investigated the effect of cardiorespiratory comorbidity on postoperative complications for patients treated for esophageal or gastroesophageal junction cancer.
PATIENTS AND METHODS
A European multicenter cohort study from five high-volume esophageal cancer centers including patients treated between 2010 and 2017 was conducted. The effect of cardiorespiratory comorbidity and respiratory function upon postoperative outcomes was assessed.
RESULTS
In total 1590 patients from five centers were included; 274 (17.2%) had respiratory comorbidity, and 468 (29.4%) had cardiac comorbidity. Respiratory comorbidity was associated with increased risk of overall postoperative complications, anastomotic leak, pulmonary complications, pneumonia, increased Clavien-Dindo score, and critical care and hospital length of stay. After neoadjuvant chemoradiotherapy, respiratory comorbidity was associated with increased risk of anastomotic leak [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.11-3.04], pneumonia (OR 1.65, 95% CI 1.10-2.47), and any pulmonary complication (OR 1.52, 95% CI 1.04-2.22), an effect which was not observed following neoadjuvant chemotherapy or surgery alone. Cardiac comorbidity was associated with increased risk of cardiovascular and pulmonary complications, respiratory failure, and Clavien-Dindo score ≥ IIIa. Among all patients, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio > 70% was associated with reduced risk of overall postoperative complications, cardiovascular complications, atrial fibrillation, pulmonary complications, and pneumonia.
CONCLUSIONS
The results of this study suggest that cardiorespiratory comorbidity and impaired pulmonary function are associated with increased risk of postoperative complications after esophagectomy performed in high-volume European centers. Given the observed interaction with neoadjuvant approach, these data indicate a potentially modifiable index of perioperative risk.
背景
心肺合并症对食管癌手术后的手术结果的影响仍存在争议。本研究调查了心肺合并症对接受食管或胃食管交界处癌治疗的患者术后并发症的影响。
患者和方法
进行了一项来自五个大容量食管癌中心的欧洲多中心队列研究，包括 2010 年至 2017 年期间治疗的患者。评估了心肺合并症和呼吸功能对术后结果的影响。
结果
共纳入来自五个中心的 1590 例患者；274 例（17.2%）有呼吸系统合并症，468 例（29.4%）有心脏合并症。呼吸系统合并症与总体术后并发症、吻合口漏、肺部并发症、肺炎、Clavien-Dindo 评分升高以及重症监护和住院时间延长的风险增加相关。在新辅助放化疗后，呼吸系统合并症与吻合口漏（优势比 [OR] 1.83，95%置信区间 [CI] 1.11-3.04）、肺炎（OR 1.65，95%CI 1.10-2.47）和任何肺部并发症（OR 1.52，95%CI 1.04-2.22）的风险增加相关，而在新辅助化疗或单独手术时未观察到这种相关性。心脏合并症与心血管和肺部并发症、呼吸衰竭和 Clavien-Dindo 评分≥IIIa 的风险增加相关。在所有患者中，1 秒用力呼气量（FEV1）/用力肺活量（FVC）比值>70%与总体术后并发症、心血管并发症、心房颤动、肺部并发症和肺炎的风险降低相关。
结论
本研究结果表明，心肺合并症和肺功能受损与大容量欧洲中心行食管癌手术后的术后并发症风险增加相关。鉴于观察到的与新辅助方法的相互作用，这些数据表明了一个潜在可改变的围手术期风险指标。
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