World J Surg. 2019 Nov;43(11):2874-2884. doi: 10.1007/s00268-019-05080-1.
Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit-level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy.
The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High-income country (HIC) and low/middle-income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20-59 versus ≥60 cases/year in the unit.
Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter-quartile range 12-50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post-operative contrast-swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001).
This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.
食管切除术后吻合口漏与发病率、死亡率和治疗费用有显著相关性。本研究旨在评估国际范围内各单位在预防和处理食管切除术后吻合口漏方面的临床实践和资源利用情况。
食管胃吻合口漏调查（OGAA）是一个专注于改善行食管切除术患者护理和结局的国际研究合作项目。全世界任何开展食管切除术的单位都可以注册参加 OGAA 研究。我们开发了一份在线单位调查问卷，并分发给每个注册参加 OGAA 的单位的首席外科医生。高收入国家（HIC）和低收入/中等收入国家（LMIC）的定义是根据世界银行的标准，而单位数量被定义为<20、20-59 和≥60 例/年。
共收到 141 个单位的回复，回复率为 77%（141/182）。报告的中位年度食管切除术病例数为 26 例（四分位间距 12-50）。仅 48%（68/141）和 22%（31/141）的单位分别有加速康复外科（ERAS）方案和 ERAS 护士。HIC 单位的吻合口吻合器吻合率明显高于 LMIC 单位（66%比 31%，p=0.005）。52%（73/141）的单位常规行术后对比吞咽吻合口评估。HIC 比 LMIC 更常采用支架置入和介入放射引流来处理吻合口漏（99%比 59%，p<0.001；99%比 83%，p<0.001）。
这项国际调查突出了基于病例数量和国家收入水平的手术技术和吻合口漏处理方法的差异。需要进一步研究以了解这种差异对患者结局的影响。
