College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK.
Dis Esophagus. 2021 Mar 8;34(3). doi: 10.1093/dote/doaa085.
Long-term survival after curative surgery for oesophageal cancer surgery remains poor, and the prognostic impact of anastomotic leak (AL) remains unknown. A meta-analysis was conducted to investigate the impact of AL on long-term survival.
A systematic electronic search for articles was performed for studies published between 2001 and 2020 evaluating the long-term oncological impact of AL. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute hazard ratios and 95% confidence intervals.
Nineteen studies met the inclusion criteria, yielding a total of 9885 patients. Long-term survival was significantly reduced after AL (HR: 1.79, 95% CI: 1.33-2.43). AL was associated with significantly reduced overall survival in studies within hospital volume Quintile 1 (HR: 1.35, 95% CI: 1.12-1.63) and Quintile 2 (HR: 1.83, 95% CI: 1.35-2.47). However, no significant association was found for studies within Quintile 3 (HR: 2.24, 95% CI: 0.85-5.88), Quintile 4 (HR: 2.59, 95% CI: 0.67-10.07), and Quintile 5 (HR: 1.29, 95% CI: 0.92-1.81). AL was significantly associated with poor long-term survival in patients with associated overall Clavien Dindo Grades 1-5 (HR: 2.17, 95% CI: 1.31-3.59) and severe Clavien Dindo Grades 3-5 (HR: 1.42, 95% CI: 1.14-1.78) complications.
AL has a negative prognostic impact on long-term survival after restorative resection of oesophageal cancers, particularly in low-volume centers. Future efforts must be focused on strategies to minimize the septic and immunological response to AL with early recognition and treatment thus reducing the impact on long-term survival.
根治性手术治疗食管癌后的长期生存仍然较差，吻合口漏（AL）的预后影响尚不清楚。本研究进行了一项荟萃分析，旨在探讨 AL 对长期生存的影响。
对 2001 年至 2020 年期间发表的评估 AL 对长期肿瘤学影响的研究进行了系统的电子搜索。使用 DerSimonian-Laird 随机效应模型进行荟萃分析，计算风险比和 95%置信区间。
19 项研究符合纳入标准，共纳入 9885 例患者。AL 后长期生存率显著降低（HR：1.79，95%CI：1.33-2.43）。AL 与医院容量五分位数 1（HR：1.35，95%CI：1.12-1.63）和五分位数 2（HR：1.83，95%CI：1.35-2.47）的研究中的总生存率显著降低相关。然而，五分位数 3（HR：2.24，95%CI：0.85-5.88）、五分位数 4（HR：2.59，95%CI：0.67-10.07）和五分位数 5（HR：1.29，95%CI：0.92-1.81）的研究中未发现显著相关性。AL 与总 Clavien Dindo 分级 1-5（HR：2.17，95%CI：1.31-3.59）和严重 Clavien Dindo 分级 3-5（HR：1.42，95%CI：1.14-1.78）并发症患者的长期生存不良显著相关。
AL 对食管重建术后的长期生存有负面影响，特别是在低容量中心。未来的工作必须集中在通过早期识别和治疗来最大限度地减少对 AL 的脓毒症和免疫反应的策略上，从而降低对长期生存的影响。
