Walsh Kevin J, Zhang Hao, Tan Kay See, Pedoto Alessia, Desiderio Dawn P, Fischer Gregory W, Bains Manjit S, Jones David R, Molena Daniela, Amar David
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Weill Cornell Medical College, New York, NY, USA.
Dis Esophagus. 2021 Apr 7;34(4). doi: 10.1093/dote/doaa090.
Vasopressor use during esophagectomy has been reported to increase the risk of postoperative anastomotic leak and associated morbidity. We sought to assess the association between vasopressor use and fluid (crystalloid and colloid) administration and anastomotic leak following open esophagectomy. Patients who underwent open Ivor Lewis esophagectomy were identified from a prospective institutional database. The primary outcome was postoperative anastomotic leak (any grade) and analyzed using logistic regression models. Postoperative anastomotic leak developed in 52 of 327 consecutive patients (16%) and was not significantly associated with vasopressor use or fluid administered in either univariable or multivariable analyses. Increasing body mass index was the only significant characteristic of both univariable (P = 0.004) and multivariable analyses associated with anastomotic leak (odds ratio, 1.05; 95% confidence interval, 1.01-1.09; P = 0.007). Of the 52 patients that developed an anastomotic leak, 12 (23%) were grade 1, 21 (40%) were grade 2 and 19 (37%) were grade 3. In our cohort, only body mass index, and not intraoperative vasopressor use and fluid administration, was significantly associated with increased odds of postoperative anastomotic leak following open Ivor Lewis esophagectomy.
据报道，食管癌切除术中使用血管升压药会增加术后吻合口漏及相关并发症的风险。我们试图评估开放食管癌切除术后血管升压药的使用与液体（晶体和胶体）输注与吻合口漏之间的关联。从一个前瞻性机构数据库中识别出接受开放Ivor Lewis食管癌切除术的患者。主要结局是术后吻合口漏（任何等级），并使用逻辑回归模型进行分析。在327例连续患者中，有52例（16%）发生了术后吻合口漏，在单变量或多变量分析中，其与血管升压药的使用或液体输注均无显著关联。体重指数增加是单变量（P = 0.004）和多变量分析中与吻合口漏相关的唯一显著特征（比值比，1.05；95%置信区间，1.01 - 1.09；P = 0.007）。在发生吻合口漏的52例患者中，12例（23%）为1级，21例（40%）为2级，19例（37%）为3级。在我们的队列中，开放Ivor Lewis食管癌切除术后，只有体重指数与术后吻合口漏几率增加显著相关，而术中血管升压药的使用和液体输注与之无关。
