National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St. James's Hospital, Dublin 8, Ireland.
Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Ann Surg. 2022 May 1;275(5):e683-e689. doi: 10.1097/SLA.0000000000004146. Epub 2020 Jul 24.
To determine the incidence, risk factors, and consequences of AKI in patients undergoing surgery for esophageal cancer.
Esophageal cancer surgery is an exemplar of major operative trauma, with well-defined risks of respiratory, cardiac, anastomotic, and septic complications. However, there is a paucity of literature regarding AKI.
consecutive patients undergoing curative-intent surgery for esophageal cancer from 2011 to 2017 in 3 high-volume centers were studied. AKI was defined according to the AKI Network criteria. AKI occurred if, within 48 hours postoperatively, serum creatinine rose by 50% or by 0.3 mg/dL (26.5 μmol/L) from preoperative baseline. Complications were recorded prospectively. Multivariable logistic regression determined factors independently predictive of AKI.
A total of 1135 patients (24.7%:75.3% female:male, with a mean age of 64, a baseline BMI of 27 kg m-2, and dyslipidemia in 10.2%), underwent esophageal cancer surgery, 85% having an open thoracotomy. Overall in-hospital mortality was 2.1%. Postoperative AKI was observed in 208 (18.3%) patients, with AKI Network 1, 2, and 3 in 173 (15.2%), 28 (2.5%), and 7 (0.6%), respectively. Of these, 70.3% experienced improved renal function within 48 hours. Preoperative factors independently predictive of AKI were age [P = 0.027, odds ratio (OR) 1.02 (1.00-1.04)], male sex [P = 0.015, OR 1.77 (1.10-2.81)], BMI at diagnosis [P < 0.001, OR 1.10 (1.07-1.14)], and dyslipidemia [P = 0.002, OR 2.14 (1.34-3.44)]. Postoperatively, AKI was associated with atrial fibrillation (P = 0.013) and pneumonia (P = 0.005). Postoperative AKI did not impact survival outcomes.
AKI is common but mostly self-limiting after esophageal cancer surgery. It is associated with age, male sex, increased BMI, dyslipidemia, and postoperative morbidity.
确定接受食管癌手术的患者发生 AKI 的发生率、风险因素和后果。
食管癌手术是一种典型的大手术创伤，存在明确的呼吸、心脏、吻合口和感染性并发症风险。然而，关于 AKI 的文献却很少。
研究了 2011 年至 2017 年间在 3 个大容量中心接受根治性食管癌手术的连续患者。根据 AKI 网络标准定义 AKI。如果术后 48 小时内血清肌酐升高 50%或从术前基线升高 0.3mg/dL（26.5μmol/L），则发生 AKI。前瞻性记录并发症。多变量逻辑回归确定 AKI 的独立预测因素。
共有 1135 例患者（24.7%：75.3%为女性：男性，平均年龄 64 岁，基线 BMI 为 27kg/m2，10.2%有血脂异常）接受了食管癌手术，其中 85%为开胸手术。总的院内死亡率为 2.1%。1135 例患者中有 208 例（18.3%）术后发生 AKI，其中 AKI 网络 1、2 和 3 分别为 173 例（15.2%）、28 例（2.5%）和 7 例（0.6%）。其中，70.3%的患者在 48 小时内肾功能改善。术前独立预测 AKI 的因素为年龄[P=0.027，比值比（OR）1.02（1.00-1.04）]、男性[P=0.015，OR 1.77（1.10-2.81）]、诊断时 BMI[P<0.001，OR 1.10（1.07-1.14）]和血脂异常[P=0.002，OR 2.14（1.34-3.44）]。术后 AKI 与心房颤动（P=0.013）和肺炎（P=0.005）相关。术后 AKI 并不影响生存结果。
AKI 在食管癌手术后很常见，但大多是自限性的。它与年龄、男性、BMI 增加、血脂异常和术后发病率有关。
